POISE TEEN CAREER AFTER-SCHOOL PROGRAM
 NEW Hours:  2:30pm-6:30pm
 Dates of After-School Program:  Duval County Public School Calendar
Cost:  No monthly charges
 ** Special events, field trips and outings may require additional fees**

NEW LOCATION:
Fields of Art Christian Academy School
Harvey's Shopping Strip
203 W 48th Street #10
Jacksonville, Fl 32208

Contact us at (904) 672.9488 or training@poisejax.com

Thank you for joining POISE Afterschool Program We are excited about our upcoming school year and events.  
Please complete the attached form to register your child for POISE Afterschool Program for ages 13-19.  Please ensure that you provide the correct email address to receive your registration package. 
Thank you and we look forward to seeing you soon. 

Note:  Program follows Duval County Public Schools calendar. 
** Special events and outings may require additional fees**

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Email *
LEGAL NAME OF PARTICIPANT *
DATE OF BIRTH *
AGE OF PARTICIPANT *
COMPLETE ADDRESS OF PARTICIPANT                    (INCLUDING ZIP CODE) *
PH0NE NUMBER *
EMAIL ADDRESS *
LAST 4 OF SOCIAL SECURITY NUMBER *
Gender *
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Race *
Parent's Name *
Name of School *
Current Duval County Public School ID Number (or previous ID number) *
CURRENT GRADE *
School Data Consent *
Do you have Special Needs? *
If Yes, What type of Special Needs
WHAT IS YOUR CAREER CHOICE WHEN YOU GROW UP? *
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NAME OF PERSON WHO REFERRED YOU (IF APPLICABLE)
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