Skip to main content
MENU

2020 APPLICATION

PROGRAM
Country
Address Line 1
City
State
Postal Code
PARENT/GUARDIAN INFO
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
PERSONS (AGE 16 OR OLDER) AUTHORIZED FOR PICK UP OTHER THAN PARENT
EMERGENCY CARE INFORMATION

IF APPLYING FOR AFTERSCHOOL, MAKE FINE ARTS SELECTION!
1st Choice
2nd Choice

Note that the Family Educational Rights and Privacy Act is a Federal law protecting student education records privacy. Parents have the right to inspect their child's records and request that errors be corrected.


ACKNOWLEDGEMENTS
I Understand That My Child Is Required To Maintain An 80% Attendance Rate.
I Understand That Proof Of Income Will Be Required For Scholarships.
I Agree That The Agency May Authorize A Doctor Of Its Choice To Provide Emergency Care If I Nor The Family Doctor Can Be Contacted.
I Give Permission For Use Of My Child's Photo And/Or Likeness In Media Related To The Program.