After School Registration 2017-2018
Your Information
Please fill out 1 per child. (You will have the opportunity to submit another response at the completion of this form. You may have to scroll up to the top of the page to do so.)
Child's Name
Your answer
Child's Age
Your answer
Birthday
mm/dd/yyyy
Your answer
Gender
Your answer
Grade (entering in Sept. 2017)
Required
School
Your answer
Does your child have any food allergies?
We need this information to purchase snakes and make sure you child is in a safe eating environment.
If yes, what foods are they allergic to?
Your answer
Parent/Guardian Name(s)
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Daytime Phone (work, etc.)
Your answer
Cell Phone
Your answer
Email Address
Your answer
How did you learn about Yes! And...'s After School Program?
Required
What in the part year has affected your child the most?
Your answer
Does your child have an area of the arts that he/she is most interested in?
Required
What do you understand to be your child's greatest challenges?
Your answer
Their greatest strengths?
Your answer
What three words best describe your child?
Your answer
Check this box if you would like information on scholarships that are available.
We do not turn away a child because of an inability to pay full cost. You will be sent a short form to complete to apply for a scholarship.
Coupon codes, any other information:
Your answer
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