POISE "Teen" Career Exploration                        After-School and Summer Camp Program 
Afterschool Hours: 3:00pm-6:00pm (high school pick up earlier)
Dates of After-School Program: Duval County Public School Calendar  
Afterschool Hours: 3:00pm to 6:pm (earlier pick up for high school) NO DROP OFFS!


Cost: No monthly charges  
T-Shirt: $20
**Special events, field trips, and outings may incur additional fees**  

LOCATION:  
POISE, INC  
1461 Rogero Road  
Jacksonville FL 32211  

Entrance: Poise classroom (back entrance)  
For inquiries, please reach out to us at (904) 672-9488 or via email at trainingpoisejax.com.  

Thank you for enrolling in the POISE Teen Career Exploration Afterschool & Summer Camp Program. We are excited about upcoming school year and planned events.   You will receive additional information via email after registration. 

Please complete the attached form to register your child for the POISE Afterschool & Summer Camp Programs for ages 13-19. Ensure you provide the correct email address to receive your registration package.  

Note: The program follows the Duval County Public Schools calendar.  
**Special events and outings may incur additional fees**  

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Email *
Are you registering for Afterschool or Summer Camp? *
Current School *
*
Participant's First Name *
Last name *
DATE OF BIRTH *
AGE OF PARTICIPANT *
Gender *
COMPLETE ADDRESS OF PARTICIPANT                    (INCLUDING ZIP CODE) *
PH0NE NUMBER *
EMAIL ADDRESS *
Gender *
Required
LAST 4 OF SOCIAL SECURITY NUMBER *
Race *
Parent's Name *
Current Duval County Public School ID Number (or previous ID number) *
CURRENT GRADE *
School Data Consent *
Do you have Special Needs? *
If Yes, What type of Special Needs
WHAT IS YOUR CAREER CHOICE WHEN YOU GROW UP? *
Participant's T-shirt size (poise shirt will be ordered) *
How did you hear about us?
Clear selection
NAME OF PERSON WHO REFERRED YOU (IF APPLICABLE) or Location of Flyer
 *
Summer Camp Flyer
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