Enrollment Form

Enrollment Form

This online application only holds a spot in the program for a child. You will be required to complete a signed copy of an enrollment form once your child begins attending a program, as per NYS OCFS Regulations.
School Child Attends:*
Child Name*
Child's Age:*
Child's Grade:*
Mother / Guardian Name
Mother / Guardian Phone Number:
Mother / Guardian E-mail:
Father/ Guardian Name:
Father / Guardian Phone Number:
Father / Guardian E-mail:
How often will your child attend? (Minimum of 3 days per week are required)
By clicking submit below you understand that this online enrollment will only act as a placeholder for your child's spot in the program and that there is additional paperwork to complete at the program site with the Coordinator.
Name of Person Completing Form*
Should be Empty: