ConnCAT Afterschool Program 2018-2019 Application
The Youth After-School Program is accepting applications for Fall 2018. For questions, please contact Stephen Driffin or Stephanie Mallard at 203-823-9823. PLEASE NOTE: THERE IS A $25 NON-REFUNDABLE REGISRATION FEE DUE AT THE TIME OF ORIENTATION. Thank you!
Child's Last Name *
Your answer
Child First Name *
Your answer
Address Line 1 *
Street Address
Your answer
Address Line 2
Unit
Your answer
Address Line 3 *
City, State, Zip
Your answer
Neighborhood *
In which Greater New Haven neighborhood do you reside? Please select one.
Grade *
During 2018-2019
Age *
Your answer
School Name *
Your answer
Date of Birth *
Your answer
Gender *
Does your child consider him/herself to be Hispanic or Latino?
Ethinicity/Race
Parent 1 Last Name *
Your answer
Parent 1 First Name *
Your answer
Parent 1 Address *
Street, Unit, City, State, Zip
Parent 1 Daytime Phone Number *
Your answer
Parent 1 Cellphone Number *
Text messages are a primary form of communication for the after school program.
Your answer
Parent 1 Email Address *
**Must provide an active email address that is checked regularly
Your answer
Would you like to receive text notifications for emergencies/occasional updates?
Parent 2 Last Name
Your answer
Parent 2 First Name
Your answer
Parent 2 Daytime Phone Number
Your answer
Parent 2 Cellphone Number
Your answer
Parent 2 Address
Street, Unit, City, State, Zip
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