Ivymount Outeach Returning Participant Application

Ivymount Outreach Returning Participant Application

Participant First Name:    

Participant Last Name:    

Check the programs you are interested in the participant attending:

  Fall Athletics Tuesdays AND Thursdays

  Fall Athletics Tuesdays ONLY

  Fall Athletics Thursdays ONLY

  Fall Art Tuesdays AND Thursdays

  Fall Art Tuesdays ONLY

  Fall Art Thursdays ONLY

  Girls Club Fall II Session (Nov 4th - Dec 16th)

  Camp LOL Fall II Session (Nov 4th - Dec 16th)

  Unstuck and On Target (session starting in January, requires a $50 application fee)

  Mythbusters (session starting in January)

  Game Time (session starting in January)

  Secrets of Friendship (session starting in January)

  Conversation Club/Street (session starting in January)


 

Participant Information

  Check here if participant information is the same as last session.  Or fill out the fields below with updated information.

Street Address:   

Address Line 2:    

City:   

State/Province/Region:   

Postal/Zip Code:   

Participant lives with:       Other please specify:   


 

Parent/Guardian Information

Parent/Guardian 1

Name:   

Relationship to participant:   

Primary Phone Number:   

Alternate Phone Number:   

Email:   

 

Parent/Guardian 2 

Name:   

Relationship to participant:   

Primary Phone Number:   

Alternate Phone Number:   

Email:   

Click "Submit" below to complete your application.

 

Please note that applications for Unstuck and On Target require a non-refundable, $50 application fee.   After submitting your application, please click on the "Pay Now" button to submit this fee. 



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