EmpowerU - Fall 2024 Pre-Enrollment Application Parent or Guardian Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email Phone (###) ### #### Parent or Guardian Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone (###) ### #### Student Name * First Name Last Name Student's Date of Brith * Please enter the DOB in the following format 00/00/0000 Explain the purpose of enrolling your child in EmpowerU. Please be as open and descriptive as possible. * How did you hear about us? City Hall Meeting My School Friend Family Member Does your child have any limitations preventing full commitment to the program. * Developing Trade Opportunities does not discriminate against any person on the basis of race, color, national origin, disability, or age in admission, treatment, or participation in its programs, services and activities, or in employment, or on the basis of sex in its health programs and activities. For further information about this policy, contact: DTO Admin - 619-343-2543 - info@developingto.org Yes No If Yes, please move to the nest question and explain limitations. Can you commit to the full program hours? * Option 1 Option 2 Please describe any and all limitations that may prevent your child from completing program activities, projects and/or homework? Please list all legal paret/guardian or adults permitted to pick your child up from the program. * Be sure to include the full name (First & Last Name), address, and telephone number. The name and address much match the adults identification card upon pick-up. We will not release your child without proper identification. Upon submitting this form you agree that all the information is complete and accurate to the best of your ability. Please type your full name and date in the box below and hit submit. * If you are accepted into the EmpowerU program, an acceptance letter with a link to pay your invoice will be sent to the email address provided above. You are not fully enrolled or accepted without the full payment on file. Thank you! Please allow administration to get back to you within 30 days with a response.
