YOUTH AFTER SCHOOL AND SUMMER K-8TH GRADE REGISTRATION

To register, please take the time to fill out the information below.

YOUTH INFORMATION
PRIMARY CAREGIVER INFORMATION
Primary Care Giver Relationship (check):
Secondary Caregiver (In case of emergency)
Secondary Care Giver Relationship (check):

Thea Bowman Center online Youth Program Parent Permission Form

By submitting this form, I give permission for my child to participate in the Thea Bowman Center’s
supervised After-School and Summer Program activities: Tutoring, Music, Martial Arts, Field Trips,
Black History and other learning activities. (Child must be in K -8 th grade)