AFTER SCHOOL PROGRAM




Enrollment Form
Please check school your child will be attending:*
UP Academy-Dorchester UP Academy-


FAMILY INFORMATION:

Parent/Guardian Name:*

Home Street Address:*
  City:*
Home Phone:
Mobile Phone:*

Email Address:*

Child(ren) Name(s) (separate by comma):*

Child(ren) DOB(s) (separate by comma):

Desired Start Date:

Please check age group of your child(ren):


*required fields

IN PARTNERSHIP WITH: