Alternatives In Person Remote Learning Registration
Event Timing: Starting January 11th - End Date TBD
Event Address: 241 E. 57th St.
Services Provided: Virtual Learning Support, free case management and therapy services, virtual programming. No Food provided until February.
Questions? Contact Daven Crump at
DCRUMP@ALTERNATIVESYOUTH.ORG
OR 773-307-2860
* Required
Student Name
*
Your answer
Pronouns
She/Her/Hers
He/Him/His
They/Them/Theirs
Other
Caregiver Name
Your answer
School Name
Your answer
Email
*
Your answer
Phone Number
Your answer
What days will you attend?
*
Monday 9am-11am
Monday 1pm-4pm
Tuesday 9am-11am
Tuesday 1pm-4pm
Wednesday 9am-11am
Wednesday 1pm-4pm
Thursday 9am-11am
Thursday 1pm-4pm
Friday 9am-11am
Friday 1pm-4pm
Required
Dietary restrictions
*
None
Vegetarian
Vegan
Kosher
Gluten-free
Other:
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