Please Select the location you are interested in: * *

971 Clinton Avenue, Irvington NJ

173 Madison Avenue, Irvington NJ

Method of Payment *

Confirmed Program for Parents

Applying for Program for Parents

Out-Of-Pocket Weekly Fee $150 (Due Wednesday's prior to the upcoming week)

START START DATE / FECHA DE INICIO / DAT KÒMANSE *

On Or After 06/23/2025

MM

DD

YYYY

Child's Name *

First Name

Last Name

Child's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of BirthDate of Birth / Fecha de nacimiento / Dat nesans *

MM

DD

YYYY

T-Shirt Size / Talla de camiseta / Gwosè mayo *

Youth X-Small

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

Adult X-Large

Mother's Name *

First Name

Last Name

Employers Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother Cell Phone Number *

(###)

###

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Father's Name

First Name

Last Name

Father Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father Cell Phone Number

(###)

###

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E1 Name *

First Name

Last Name

E1 Phone *

(###)

###

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E2 Name *

First Name

Last Name

E2 Phone *

(###)

###

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Name / Nombre / Non *

First Name

Last Name

*

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