New City Kids After School Program Intake Form 2024-2025

After school program will kick-off Tuesday, September 3, 2024

If applying after this date, please expect a follow up within 2-4 days.

Our program runs Monday, Tuesday, Wednesday, Thursday from 3:30 pm - 6 pm

Transportation is provided for students who attend Harrison Park and Westwood Middle, Walker Charter, & Sibley

Registration will be on a first come first serve basis. 

A staff member will contact you via email or phone call when we receive your application. 

You can contact Ms. Wendy Diaz at 616..773.8589 or email at wendy.diaz@newcitykids.org with any questions. 

Sign in to Google to save your progress. Learn more
Email *
Student’s First Name *
Student’s Last Name
Child’s Date of Birth *
MM
/
DD
/
YYYY
Gender *
Primary Language spoken at home *
School
2024- 2025 school year
 *
If other school, which one?
Grade 
2024- 2025 school year
 *
Home Address 
Street, apt. #, city, state, zip
 *
Is this student a returning NCK student? *
Please list any other children your child is related to that are currently in our program *
Phone Number
What is the best day out of the week to call you?
Clear selection
What is the best time of day to call you?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of New City Kids.

Does this form look suspicious? Report

Google Forms