POOF: New Student Registration Form
$45.00 application fee will be waived until next School year 2023-2024

Please complete this application form if you are interested in your student(s) participating in POOF Teen program. Hours 3:30pm-8:00pm Monday - Thursday. This is a free program. Parents are required to attend one meeting in the first 90 days of the program. 
Program outline:
4:30-5:30 Homework time with tutor
5:30-6:30 Financial Empowerment/ World Travel/Life Preparation 
6:30-7:30 Pathway study and hands on practice. 

Program will run through September 12th- June 31st. December is Entrepeneur month. We will have three Cohort. Teens can only be enrolled at the start of cohort. Once your teen is in the program, they are good for the school year.  

Once you complete the form, click the Continue button at the bottom. When your form is received a representative from our team will contact you to submit payment. Once payment is received your teen can start. 
If you have any questions, feel free to contact us 919-381-5479

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Email *
Parent Name: *
Parent Phone Number: *
Student Name *
Gender *
Birthday *
Student Age: *
Grade *
 School attending *
Your relationship to the student(s): *
Best method of contact: *
Select three programs of interest:  *
Any daily medication 
Teen allergic to food or other substance If so name food or substance to be avoided and procedure to follow if reaction occurs)? *
Teen have any other allergies? *
Does your teen have Asthma? *
If your teen has Asthma, will your child have an inhaler on site. *
Does your teen have an epi-pen? *
Does your teen have Epilepsy/Seizures? *
Is there any  physical condition we should be aware of? *
Teen have any Behavioral issues? If yes please explain. *
Can you provide last report card? *
Are you willing to send report cards and progress reports during the school year? *
Will transportation be a issues? *
Do you provide consent for the child photograph to be released? *
In case of an emergency what Hospital is Preferred   *
Emergency Contact name/number *
Does your teen have a saving account? If so with who? *
Does your teen have a passport? *
Do you have any questions or concerns? If so let us know here. Or give us a call 919-381-5479 *
A copy of your responses will be emailed to the address you provided.
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