CRE8 Your Future Enrollment Form

CRE8 Your Future Spring 2023 Registration

April 2023 - May 2023. The Robert Randolph Foundation CRE8 Your Future Academy is an 8 week career prep program geared to high school students in 9 – 12 grade. During the Spring 2023 Session, students will explore STEM careers as well as learn the basics of coding.
CHILD INFORMATION:
Child Name*

First NameLast Name
Child Birth Date*

MonthDayYear
Grade*
Name of School*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent's Phone Number*

Area CodePhone Number
E-mail*
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number

Area CodePhone Number
Medical Concerns
Does your child have any allergies?
Program Structure - Begins April 6, 2023.

The program will last for 8 weeks with Thursday sessions from 6pm - 8pm (via zoom) and Saturday sessions from 10am - 2pm. Saturday sessions will be held at 491 Orange St., Newark, NJ 07107.
The program will be for a duration of 8 weeks with Thursday evening online sessions. Does your child have access to a laptop or computer at home?

YesNo
During the 8 week session, there will be in-person Saturday sessions from 10am - 2pm. Can you provide transportation for your child to and from the Saturday sessions?

YesNo
During the session, our media team will promote the program on social media platforms. Your child's photo may be included in the promotions.

I understand
Consent

I have read the above information and approve the application and participation in the CRE8 Your Future Program. Your email will also be included in upcoming program announcements.(signature of parent/guardian required if applicant is under 18 years of age).
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CRE8 Your Future Spring 2023 Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

MEDICAL INFORMATION

Program Structure - Begins April 6, 2023.

Consent