SCHOOL DAYZ ACADEMY 2024-2025
100 Hour Mentorship & Enrichment Program
Participant #1 Information
*
Firt Name
Last Name
Camper #2 Information
First Name
Last Name
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
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.
Format: (000) 000-0000.
Email
*
example@example.com
How did you Learn About the program
Laquashia Flanagan
Ashley Willis
Patashia Bolden
Other
Please describe Other(school, church, civic group)
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 28 2-4. Alternative Orientation will be Monday, September 30 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 29, 2024-April 28 2025. Mentee will meet with team & leaders bi monthly, the 2nd & 4th Monday Monday 4-7:30 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
*
Saturday Sessions Only
Monday Sessions + Saturdays(full program/to receive award, must register for this option)
Mondays Only
Specialized Community Events
HATS & HOPE only
Graduation and Pre Summer Camp Event Only
Emergency Contact Information
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
OPEN HOUSE & Registration will be held Saturday, September 28th, 2-4pm and it is a mandatory session. I understand in order to activate my teens enrollment, we must be in attendance. Please sign
*
By signing below, I agree to supporting my child in attendance, participation and opportunity to grow their leadership skills
*
Submit
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