Application For Enrollment

Supervised study for 3rd-6th graders at Millersville Mennonite Church on Thursdays and Fridays 8 AM- 3 PM from 9/10/20 - 11/20/20 (unless disrupted). Space is limited. $30 per family enrollment fee (assistance is available if needed). Please answer each question thoroughly.

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* 1. Parent/Guardian's Name(s)

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* 2. Child's Name and Grade Level

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* 3. Name(s) of other children and grade levels you are applying for.

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* 4. Household Size

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* 5. Total Household Income (counting jobs, public assistance, SSDI, child support and food stamps)

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* 6. Child's Elementary School

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* 7. Why do you need this service? Child care difficulties? Job Schedule?

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* 8. Child's allergies, special needs, medical conditions, and anything else we should know. 

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* 9. Names and work schedules of all adults in household

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* 10. Email Address AND Phone Number

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