SCHOOL DAYZ ACADEMY 2023-2024
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
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, August 19 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 once per week
*
Yes
No
Mentorship Program will be hosted Sept 1, 2023-May 1, 2024. Mentee will meet with team & leaders every Monday 5-7:30PM and the First Saturday each month 11-2pm. 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 weekly
Yes
No
My child will only attend monthly Saturday Sessions
Yes
No, she will also attend Monday evening sessions
My child is committed to attend our Mentorship program, Monday evenings 5-7:30PM & the 1st Saturday each month 11-2pm
*
Yes
No
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
*
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