Please Select the School you are interested in: *

SHELIA Y. OLIVER ACADEMY

CICELY L. TYSON ELEMENTARY

WHITNEY HOUSTON ACADEMY

WAHLSTROM ACADEMY

J. GARFIELD JACKSON ACADEMY

TOUSSAINT LOUVERTURE

LANGSTON HUGHES

BARRY GARVIN (Begins 9/16/20204)

GORDON PARKS (Begins 9/16/20204)

BOWSER SCHOOL (Begins 9/16/20204)

Method of Payment *

Confirmed Program for Parents

Applying for Program for Parents

Out-Of-Pocket $80/per week

START DATE *

On or after September 9, 2024

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Child's Name *

First Name

Last Name

Child's Date of Birth *

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DD

YYYY

Child's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Name

First Name

Last Name

Mother Employers Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother Cell Phone Number

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Father's Name

First Name

Last Name

Father Employers Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father Cell Phone Number

(###)

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E1 Name *

First Name

Last Name

E1 Phone *

(###)

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E2 Name

First Name

Last Name

E2 Phone

(###)

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Name *

First Name

Last Name

*

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