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Parent Information

Education & Employment

Child(ren) Information

Ownership

Please check, if you have any of the following in place for your child (ren)

I certify that my answers are true and complete to the best of my knowledge. I know there is a $50 program fee plus the additional $15 fee for more then one child/parent. I am submitting that fee with my application. Please be advised that the $50 (plus additional $15 for more than one child or adult) MUST be paid in FULL before you and your child(ren) can begin the program.


I am committed to attending the weekly sessions and completing the assigned tasks.