ENROLLMENT FORM
Email address *
Please make sure to use a laptop or desktop computer while filling our enrollment form. We have had problems with the mobile version in the past. Thank you. *
Your answer
Do you prefer *
Preferred class schedule *
Child Information
First Name *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Race and Ethnicity *
Your answer
Language(s) spoken at home *
Your answer
Parent / Guardian informations
First Name *
Your answer
Last Name *
Your answer
Relationship to child *
Your answer
Address *
Your answer
City *
Your answer
Cell Phone *
Your answer
Are you interested in a volunteer mentor opportunity in our program? *
Do you wish to apply for a scholarship? *
Please briefly state why you would like your child to attend this program. *
Your answer
How did you hear about us? *
Your answer
What is the best way to contact you upon receiving your enrollment application to meet with you and the applicant *
Please note that there is a non-refundable enrollment application fee of $50 for the year (Link on the confirmation page). The first month of tuition is due by 07/01/2020 to secure your spot in our program. *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Barnacles and Bees. Report Abuse