Youth After School Program Registration Form

Youth After School Program Registration Form

Ages 6-16 (Monthly Fees Apply) Donations Accepted Cash App/Venmo $IAmWeFoundationCLT Email: IAmWeFoundation@hotmail.com Phone: 980.272.1198
Parent Name

First NameMiddle NameLast Name
Mobile Number
Parent E-mail
example@example.com
Second Parent Name

First NameMiddle NameLast Name
Second Phone Number
Student 1 Name (Age 6-16)

First NameMiddle NameLast Name
Student 2 Name (Age 6-16)

First NameMiddle NameLast Name
Student 1 Birth Date

MonthDayYear
Student 2 Birth Date

MonthDayYear
Student 1 Gender
Student 2 Gender
T Shirt Size

Youth SmallYouth MediumYouth LargeYouth Extra LargeSmallMediumLargeExtra LargeOther
Assistant living (IE - Group Home, Halfway Housing or Shelter)Single ParentTwo Family Household
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Select After School Program Classes

Youth Mechanic Class (4 Sessions)Youth Culinary Class (6-8 Weeks)Youth Basketball Referee Training Class (6-8 Weeks)Barber Training Class (6-8 weeks)After School Tutor ProgramBeyond Basketball Initiative (Feb-Nov)
Signature

Clear
Should be Empty: