Registration
Please read all questions thoroughly and answer them as accurately as possible.
Email address *
Parent/Guardian Information
Parent/Guardian FULL Name *
Primary Phone Number *
2nd Parent/Guardian FULL Name *
Secondary Phone Number *
Secondary Email *
Emergency Contact Name *
Needs to be other than yourself or parent/guardian 2
Relation to Child(ren) *
Needs to be other than yourself or parent/guardian 2
Emergency Contact Phone Number *
Needs to be other than yourself or parent/guardian 2
Please list the FULL names of any other adults you approve to pick-up your child(ren) from our classes *
Is your family currently enrolled in our after school Youth Mentorship Program? *
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