AFTER SCHOOL PROGRAM
APPLICATION FORM


Dear Parents and Applicant:
Thank you for your interest in the Atius Youth Technology After-School Program (AYTP) at Information Technology Academy (ITA). Please fill out this application form completely.

The registration deadline is Friday, August 19th, 2017. Your child will not be registered until the payment is made.

Child's Name:


Gender:  Male Female

Grade & Group: 

Address:


School:



Parent/Guardian Name:


Parent/Guardian Address: (leave blank if same as child's)


Email :


Parent/Guardian Phone: Do not use symbols: "( , ) , [ , ] , < or >"


Would you be interested to subscribing to our Newsletter:  Yes No

Comments, Inquirys or Questions: