Social Group Interest Form
Please take the time to fill out this form. Upon receipt, those new to the center will be contacted to set up a "Meet and Greet" appointment. This will allow us to learn about your child and determine which group is most appropriate.
Email address *
Child's Name *
Your answer
Grade (2018-2019) *
Child's Date of Birth *
MM
/
DD
/
YYYY
Parents Names *
Your answer
Phone Number *
Your answer
Address *
Your answer
My Child IS available for on the following days/times. (Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
1pm
2pm
3pm
3:15pm
3:30pm
3:45pm
4pm
4:15pm
4:30pm
4:45pm
5pm
5:15pm
5:30pm
5:45pm
6pm
I am interested in the following group: *
Required
A copy of your responses will be emailed to the address you provided.
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