All-Star Academy Program Interest Form Question Title * 1. Where did you hear about All-Star Academy? Email notification/flyer posting from school Postcard in mail Other (please specify) OK Question Title * 2. What Program are you interested in? (Check all that apply) Preschool After-School Program All-Star Kiddos™ Program Restorative Correction™ OK Question Title * 3. Please provide the birthdate(s) of your child(ren) you are looking to have attend. OK Question Title * 4. What is your biggest struggle or goal for your child(ren) right now? Please explain in as much detail as possible. OK Question Title * 5. Will your child need transportation from their school to our facility? If so, what school do they attend? OK Question Title * 6. What day(s) are you looking to have your child participate in a program? OK Question Title * 7. Please describe your family so that I may have some background information. OK Question Title * 8. Please enter your contact information. Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number OK DONE