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S.H.A.P.E. COMMUNITY CENTER, INC.
2010 Summer Family Strengthening & Empowerment Program
Pre-Registration Form
***Completion of this form does not mean your child will go on this years Freedom Tour
Full Tour Payment Must Be Made In Order To Attend ***
 

NAME OF CHILD ___________________________________________ Sex M F Age________ Birthdate ____________________________

Address_______________________________________________________City/State.Ziip______________________________________

Parent/Guardian's Name__________________________________ Day Phone____________________Eve.Phone____________________

Name of School_______________________________________________________________Grade (Aug 10)_______________________

Signature of Parent/Guardian_____________________________________________________Date_______________________________

Has your child previously attended any S.H.A.P.E. Center Programs? Yes   No If yes, when ________________________________________


For office use:      Received by_____________________________Date application received_______________________________

Registration fee: $_______________ Date:________________________________Method:__________________________________
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SUMMER Program Enrollment Procedures
*Failure to follow these procedures could jeopardize your child's participation)*
As a summer program participant

*Adult caregiver (parent/guardian) must attend S.H.A.P.E.'s weekly Parent Support Group meetings.
*Adult caregiver (parent/guardian) must support S.H.A.P.E.'s policies & procedures.

To be considered for enrollment in S.H.A.P.E. Community Center's 2010
SUMMER Family Strengthening & Empowerment Program
*Children must be 5 years old - 15 years old.
*Enrolled and attending accredited school.
*Complete the above pre-registration form for each child.
*Return the form to 3815 Live Oak to Ifueko, Edith. or fax to 713-521-1185 or mail to P.O. Box 8428 ; Houston,  TX 77288 Attn:Edith
*Attend interview as scheduled!
Interviews will take place during HISD Spring Break, March 15-19, 2010.
Re-scheduling of interviews are not guaranteed.  Upon acceptance in the Program, parents/guardian must:
*Complete Youth Enrollment package (Youth Enrollment Form, Children's Media Release, Verification Form, Adult  Enrollment Form, Adult Media Release.
*Submit up to date immunization record.
*Copy of child's last report card.
*FEES - Payment of pre-registration fee ($50 per child) secures space in program & is NOT REFUNDABLE...
*ATTENTION PREVIOUS PARTICIPANTS: Taken into consideration for participation in the 2009 Summer Program will be:  Parent Support Group attendance; fulfillment of financial obligation.