Student Profile

Legal First Name*

Last Name*

Nickname/Preferred Name

Child Grade

Child School(s)

Child Age*

Home Address

Street*

City*

State*

Zipcode*

Household Info

Single ParentDual ParentGuardianOther

Parent Info

Parent Name(s)*

Parent Phone*

OK to text

Parent Email*

Preferred Location

Brooklyn, WilliamsburgBrooklyn, Park SlopeBrooklyn, Sheepshead BayBrooklyn, Dyker HeightsManhattan, Upper East SideManhattan, Upper West SideManhattan, East VillageManhattan, TribecaQueens, Rego ParkQueens, Fresh MeadowsStaten Island, GrasmereStaten Island, CharlestonStaten Island, WillowbrookParamus, NJ

Additional Message

How Did You Hear About Us?*

Upon clicking “Apply” you will be taken to our Step 2 on our payment page. I understand that this application is to be filled out along with a $100.00 deposit. The deposit will be credited to your program enrollment fee should you choose to enroll upon your child’s acceptance into the program. The deposit is nonrefundable. Upon receipt of your application, the center director will contact you to schedule a free placement test along with a classroom observation session to determine eligibility into the program. You will later be notified of acceptance via email.

I agree to the above statement