21st Century Student Application 2023-2024

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The 21st Century After School Academy will provide academic enrichment along with various activities, programs and services to enhance the growth and development of our elementary scholars and their families. This program will be available at the following locations:

Balmville, Horizons-on-the-Hudson, Gidney Avenue Memorial School, and Vails Gate.

Email *

Record my email address with my response

Student Last Name *

Student First Name *

Student School for 2023-2024 *

Balmville

Gidney Avenue Memorial School (GAMS)

Horizons-on-the-Hudson (HOH)

Vails Gate

Student's Daytime Teacher *

Student Grade 2023-2024 School Year *

Kindergarten

First

Second

Third

Fourth

Fifth

Is the student an English Language Learner? *

Yes

Student Identification Number, if known

Last Name of person completing form *

First Name of person completing form
*

Relationship to Student *

Please provide an email for future correspondence. *

Please provide an emergency contact name (First and Last) and phone number. *

Does your child(ren) require bus transportation home *

Yes, my child(ren) will need bus transportation home.

No, my child(ren) will be picked up.

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