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
or text/call 608-843-0845 with any questions!
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Parent First and Last Name
Child's Age as of September 5, 2023
Child's Date of Birth
Elementary School for 2023-2024 School Year
Grade in School for 2023-2024
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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