Friendly House Teen Program 23-24 Registration

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Welcome families! This is our official application to register your child to our Teen Program which starts September 11th. Just a few reminders, we have a MANDATORY parent orientation that you must attend on September 5th or 8th (will send an email with more information soon). Your child is not fully registered until you attend this meeting. If you do not come to this orientation your child will not be able to attend our program. We have only have 20 spots! If you have any questions or concerns please contact the Youth Department Director Alyssa Corazzini via phone at (267) 235-9754 or email at acorazzini@friendlyhousema.org

Teens in grades 7-12 can register for the Friendly House Teen Center. This drop-in program for teens is free and features a mentoring program, basketball training, financial literacy, cooking & baking, homework help, college readiness and features our annual HBCU tour. The goal of the teen program is to offer a variety of recreational/educational activities that helps teens recognize and effectively deal with the changes and complexities of teenagers’ life today.

Child First Name *

Child's Last Name *

Age *

What grade is your child in? *

7-8

9-10

11-12

Required

Date Of Birth *

YYYY

Gender *

Male

Female

Prefer not to say

Other:

School Attending *

Address (Please put Apartment Number, City, State and Zip Code)
*

Ethnicity *

Hispanic/Latino

Not Hispanic/Latino

Race *

White

Black/African American

Asian

American Indian/Alaskan Native

Native Hawaiian/Other Pacific Islander

American Indian/Alaskan Native and White

Asian and White

Black/African American and White

American Indian/Alaska Native and Black/African American

Other:

Required

Does your child have any allergies, illnesses or conditions?
*

Is your child taking any medication?
*

Does your child have any specialized behavior support? IEP, 504, etc.
*

Yes

Required

What language does your child speak at home?
*

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