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  • CLAP Summer Registration

    Primary Care Hours: 8:00 a.m. to 6:00 p.m

  • IMPORTANT DISCLAIMER: Please ensure you have all required documents ready before starting this form. It is recommended to complete the form in one sitting on a phone or computer, as leaving the page or delaying completion may result in loss of progress and require restarting the application.

    Required documents include:

    • Child’s report card clearly showing the child’s name, grade, and student ID
    • A utility bill or government-issued mail (such as housing assistance or food assistance eligibility documents)
    • A notarized letter (if applicable or requested based on your situation)
    • Parent or guardian’s valid driver’s license or state ID
    • A clear photo of the child

    Failure to provide complete and legible documents may result in delays, additional review, or denial of the application.

  • PLEASE BE ADVISED THAT ALL SITES ARE CURRENTLY FULL AND REGISTIRING YOUR CHILD WILL PLACE THEM ON A WAITLIST

     

  • Child's Information

  • Grade (2025-2026)*
  • Gender*
  • Is Child Proficient in English?*
  • Previously Registered*

  • We’re sorry, this site has reached full capacity. You may join our waiting list or choose another available site.

  • What language(s) does the child/youth feel comfortable communicating in? (Select all that apply)*
  • Additional/Other Language(s) spoken at home:*
  • Do they attend a private school?*

  • We're sorry. Your child must be 6 - 11 years old by June 8, 2026 to register.

  • FAMILY INFORMATION

  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Is the participant a child of a Military family?*
  • Migrant Farm Work:*
  • Dependency System:*
  • Delinquency System:*

  • EMERGENCY CONTACTS AND AUTHORIZED PICK UP

    Note: In case of an emergency, at least one parent, guardian or designated emergency contact person needs to be available to respond to the site within 15 minutes. Responding party should be authorized to make an emergency medical decision on behalf of the child.

  • Emergency Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Person(s) Authorized to pick-up child from program (Other than Parent/Guardian)

    Your child will not be released to any person not listed herein.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • MEDICAL INFORMATION

    I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care if warranted.

  • I,* , parent/legal guardian of* hereby disclose the following information/condition of my child.

  • Does your child have health insurance (ex., private insurance, KidCare, Medicaid)?If you are interested in other services funded by The Children’s Trust or need to find affordable coverage, please call 211 or visit www.thechildrenstrust.org*
  • Does your child have any allergies (ex., food, medicine)?*
  • Does your child use an EPI Pen?*
  • Does your child know how to use the EPI Pen?*
  • Does your child have a documented medical condition or a disability?*
  • If yes, how would you best classify the type(s)? (check all that apply): What conditions does your child have that are expected to last for a year or more? (Mark all that apply)*
  • If yes for any of the above, do you have (check all that apply):*
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  • We want to get to know your child better so we can provide the best possible experience in our programs. Please tell us more about your child. What are the main ways your child communicates? (Mark all that apply)*
  • What, if any, help does your child receive at this time? (Mark all that apply)*
  • Does your child have a therapist who will need to be present on-site?*
  • Do any of the conditions marked above make it harder for your child to do things that other children of the same age can do?*
  • To support your child’s successful participation in this program, in what areas might s/he need extra assistance?*
  • Do you authorize the City of Hialeah to transport the participant to and from program/events/field trips sponsored and/or approved by the After-school Program.*
  • We will be having pool days as part of our activities. Could you please let us know if you would like your child to participate?*
  • Does your child know how to swim? A life Jacket will be provided.*
  • Date
     - -

  • Please upload your documents below:

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  • Report Card clearly shows:*

  • Incomplete report cards will be automatically rejected.

  • NOTICE: Bills not issued in the name of a parent or legal guardian will require additional verification and are subject to review or denial. Approval may be delayed if proper supporting documentation is not submitted, such as notarized letter from landlord or lease agreement. 

  • NOTICE: Utility bills and government-issued mail are preferred. If you submit a bank statement or any other type of mail, the parent/guardian driver's license or state ID MUST match BOTH the name and address shown on the document being submitted. Documents with non-matching information may require a notarized letter or additional verification and may delay processing.

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  • Date
     - -

  • Please note that submitting a registration form does not confirm your enrollment in the program. To complete your registration, payment must be made at our main office. Additionally, if any required documents are missing, your registration will be returned for completion.

  • We're sorry, our program is only available to Miami-Dade County residents.

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