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Request to begin enrollment process for Options for Learning After-school TK/K

This form is not an application for services. This is the first step in the enrollment process and preliminary determination of eligibility for services.

Parent/guardian's first name*

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Parent/guardian's last name*

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Parent/guardian's phone number*

Number Required

Child's full name*

Answer Required

Child's date of birth*

Answer Required

Home street address*

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City*

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State*

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Zip code*

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School that you child attends*

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Thank you for your inquiry. Please allow two business days for a response.

Confirmation Email

Confirmation Email *

Email Required