School-Age

Thank you for your interest in our School-Age program. Tell us a little more about yourself and we'll contact you about enrolling.

School-Age Potential Participant

Let us know a little about yourself to help us get you started with our School-Age Program. Please Note: Completing this form does not guarantee enrollment. Our intake staff will contact you to set up an appointment to cover eligibility requirements, availability, etc.

Name*
Email*
Phone
Family Information
We'll cover more specifics during your intake appointment, but your responses here can help us get started with the process. Our program serves kids ages 5-12; please provide names and birthdays for your children who meet these age requirements.
Child 1*
Birthday*
MM slash DD slash YYYY
Child 2
Birthday
MM slash DD slash YYYY
Child 3
Birthday
MM slash DD slash YYYY
Child 4
Birthday
MM slash DD slash YYYY
Additional comments
Name
This field is for validation purposes and should be left unchanged.