21st Century Student Application 2023-2024
The 21st Century After School Academy will provide academic enrichment along with various activities, programs and services to enhance the growth and development of our elementary scholars and their families. This program will be available at the following locations:
Balmville, Horizons-on-the-Hudson, Gidney Avenue Memorial School, and Vails Gate. 
Email *
Student Last Name *
Student First Name  *
Student School for 2023-2024  *
Student's Daytime Teacher *
Student Grade 2023-2024 School Year *
Is the student an English Language Learner?  *
Student Identification Number, if known
Last Name of person completing form  *
First Name of person completing form
Relationship to Student *
Please provide an email for future correspondence.  *
Please provide an emergency contact name (First and Last) and phone number.  *
Does your child(ren) require bus transportation home *
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