ConnCAT Safe Space Learning Hub Fall Program-2020 6th-9th grade
Welcome to ConnCAT's newly designed Safe Space Learning Program. This is a 10 week program that will only accommodate 32 STUDENTS. Selection will be based as evenly as possible by grade and gender. Please fill out the application and note the details below:

DETAILS

- Program Start Date: September 8, 2020(Program will follow NHPS)
- Hours: Mon - Fri 8:00 am-3:30 pm (Program hours are also contingent upon NHPS hours)
- Parents must arrange transportation for drop-off/pick-up

APPLICATION GUIDELINES
- Parents/Guardians must submit 1 application PER CHILD.

- Our program heavily relies on text and email to contact parents. Please provide us with ACTIVE phone numbers and/or email addresses that you check regularly.

- Please click on "SUBMIT" at the very end of the online form to ensure delivery.

*Open enrollment. Parents will be notified via email of their acceptance status no later than September 3, 2020. All other applications will be placed on a Wait-List.

*Realizing the ever-changing current events regarding the COVID-19 virus, ConnCAT reserves the right to adjust program dates and times accordingly if deemed necessary.

Questions? Contact Steve Driffin (sdriffin@conncat.org); Stephanie Mallard (smallard@conncat.org)
Child Last Name *
Child First Name *
Address *
Street, Unit, City, State, Zip
Grade *
GRADE DURING FALL 2020
Age *
School Name *
Date of Birth (Please manually enter the year) *
MM
/
DD
/
YYYY
Gender *
Does your child have a sibling applying for the ConnCAT Safe Space Learning Hub? *
If your answer is YES, please type their sibling's name(s) in the space provided. A separate application MUST be completed for each child.
Required
Sibling Name(s)
Do you consider your child to be Hispanic or Latino?
Clear selection
Ethinicity/Race
How did you first hear about the ConnCAT Safe Space Learning Hub? *
Required
Parent 1 Last Name *
Parent 1 First Name *
Parent 1 Street Address *
Street and (Unit #)
City *
Zip Code *
Parent 1 Cell Phone Number (Example: (203) 111-1111) *
Parent 1 Daytime Phone Number (Example: (203) 111-1111) *
Parent 1 Email Address (please ensure email is correct) *
Would you like to receive text notifications for emergencies/occasional updates? *
Remind 101 is a free text message system and is our primary form of mass communication during the summer program. You will NOT be enrolled automatically, but will need to follow a set of instructions on your phone to be enrolled once your child has been admitted to the program. This is MANDATORY for ALL accepted parents.
Parent 2 Last Name
Parent 2 First Name
Parent 2 Cellphone Number (Example: (203) 111-1111)
Parent 2 Daytime Phone Number (Example: (203) 111-1111)
Parent 2 Street Address
Street and (Unit#)
City
Next
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