Program Registration Interest Form

Parent/Guardian Name

Phone Number

Number of Children I am Interested in Registering

Age of child

Age of child - if multiple

What neighborhood does your family live in? - ¿En qué vecindario vive su familia?

Centennial
Rockwood
Montavilla
Other
We typically only allow new registrations from families within one of our three neighborhood-based service areas

Is your family or child(ren) experiencing any of the following?

Loneliness
lack of meaningful social connection or companionship
Isolation
lack of social connection, support, or interaction
Anxiety
feelings of worry, nervousness, or unease
Depression
persistent feeling of sadness, hopelessness, and loss of interest or pleasure in daily activities
New to the Neighborhood
Did your family move from another city, country or area of the city in the last 2 years?
Cultural Underrepresentation
Does your family identify as an underrepresented or marginalized community member?
Limited Access to Activities
My child does not have access to out of school activities due to financial challenges
None of the Above

If You Said "None of the Above": what do you hope your family gains from our program?

Which days of afterschool programming do you prefer?

Will your child(ren) have a way to get home from their activity site?

We will follow up within five days. If you have questions in the meantime, please send us an email at [email protected]

Thank you!