OUT OF SCHOOL CARE
Wait List Form

Thank you for your interest in joining our Out of School Care Program!
Please complete the form below, and our team will be happy to follow up with you as spaces in our program become available.

For more information or to confirm your position on our list, please contact our Out of School Care Program Assistant Director at kezyac@cityreach.org

Child Name

First Name

Last Name

Child Birthdate

MM

DD

YYYY

Parent Name

First Name

Last Name

Email

Phone

(###)

###

####

Date of expected entrance to our Out of School Care Program

MM

DD

YYYY

I would like to learn more about CityReach programs, events and updates.

OUT OF SCHOOL CAREWait List Form

OUT OF SCHOOL CARE
Wait List Form