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Child’s First Name
*
Child’s Last Name
*
Date of Birth
*
Gender
*
Male
Female
School Currently Attending
*
Bain Elementary
Mint Hill Elementary
Queens Grant
Matthews Charter
Mint Hill Middle School
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Parent’s Name
*
Relationship With Child
*
Parent’s Email Address
*
Parent’s Phone Number
*
Desired Start Date
*
Program Interested In
*
After School Full Time (4-5 days/week)
After School Part Time (3 days or less/week)
Summer Camp Full Time (4-5 days/week)
Summer Camp Part Time (3 days or less/week)
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