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Enrollment Request Form - Mosaic Afterschool Club 2023-2024
Completion of the Enrollment Request Form will begin your Club Application process! Because our program has limited space,
we expect that submission of this form indicates serious interest and full intent to enroll in the program if offered a spot.
If we have the spot available for your child, completion of this form will begin enrolling them. Invoices for a non-refundable deposit equal to two weeks tuition and an Enrollment Agreement for you to sign will be sent to you by email.
If we do not have your requested days available, we will be in touch with you to discuss other options!
Please complete one form for EACH child in your family that you would like to enroll in Club!
For more information, please see
www.creativesoulcamp.com/mosaic
Email
jamie@creativesoulcamp.com
or text/call 608-843-0845 with any questions!
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* Required
Email
*
Your email
Parent First and Last Name
*
Your answer
CHILD
Last
Name
*
Your answer
CHILD
First
Name
*
Your answer
Child's Age as of September 5, 2023
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's Pronouns
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Elementary School for 2023-2024 School Year
*
Your answer
Grade in School for 2023-2024
*
Choose
K
1
2
3
4
5
I confirm that I am requesting enrollment for the Monroe Street Arts Center and/or the Randall Elementary Location of Club for the 2023-2024 School Year.
*
Yes, I would like to enroll for the 2023-2024 school year at either Monroe Street Arts Center or Randall Elementary!
Whoops! No, I'm looking for something else. Please reach out to me to discuss other options!
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