SCHOOL DAYZ ACADEMY 2024-2025
100 Hour Mentorship & Enrichment Program
Participant #1 Information
*
First Name
Last Name
Camper #2 Information
First Name
Last Name
Phone
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Race/Ethnicity
*
African American
Latina American
Caucasian
Native American
Asian American
Other
Middle or High School
*
Clarke Middle
Hilsman Middle
Clarke Central
Classic City
Cedar Shoals
W.R. Coile Middle
Burney -Harris-Lyons Middle
Other
Age of Child #1
*
11
12
13
14
15
16
17
Age of Child #2
*
11
12
13
14
15
16
17
Parent Information
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Number of people living in the household
*
1
2
3
4
5
6
7
8+
Household Income Limits are based on family size. Please check the range of your income
*
$14,500-$24,000
$24,500-$38,000
$38,500-$59,000
$59,000-$78,000
$79,000+
One Parent Orientation Meeting will be held on Saturday, September 7 at Noon. Location: 645 Hawthorne Avenue (Divas Who Win)Bring teen + a friend. Parent Session is mandatory for enrollment. Will you attend with your teen
*
Yes
No
My Child would benefit from tutoring
*
Yes
No
Mentorship Program will be hosted September 14, 2024-April 28 2025. Mentee will meet with team & leaders bi monthly, the 2nd & 4th Monday Monday 4-7pm and FOUR Saturdays(6-8 hours) for excursions throughout the school year. Is there any specific challenge or opportunity you’d like our team to focus on during this time?
*
Please describe
My child will eat Dinner at Divas biweekly weekly
Yes
No
My child will only attend monthly Saturday Sessions
Yes
No, she will also attend Monday evening sessions
Emergency Contact Information
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
By signing below, I agree to supporting my child in attendance, participation and opportunity to grow their leadership skills
*
Submit
Should be Empty: