RAB Before & After School Interest Form

Thank you for your interest in the Rising Above Boundaries Before and After School Program. Please complete the form below to express your interest in enrolling your child. This form helps us plan and prepare to meet the needs of our families.

We are an OCFS licenced program for working families. We accept DSS childcare subsidy and Child Care Council Westchester Works Scholarship Program.

Before School starts at 7am-9am $50/week
After School ends at 6pm - $100/week

Childs Full Name

Date of Birth

Date

Grade in Fall 2025

School Attending

ParentGuardian Name

Relationship to Child

Phone Number

Email Address

example@example.com

Please check the program(s) you are interested in:

Before School Program (Start time: 7:00 AM)After School Program (End time: 6:00 PM)

Preferred Start Date

Date

How many days per week would you need care

Please list any allergies, special needs, or accommodations:

Additional Comments or Questions:

A member of the Rising Above Boundaries team will follow up with you to provide more information about enrollment and availability. Thank you!