YACS Burmaster at YALA 21st CENTURY AFTER SCHOOL ARTS AND INNOVATION PROGRAM !

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Free to YACS Burmaster students registered for the 2022-2023 school year.
The program begins August 22, 2022 and ends May 19, 2023.
Program time will be from 4:10 - 6:10 p.m. M, T, Wed and Th of every week(except student/school holidays).
If you have any questions/concerns please email: burmaster.afterschool@yacs.org

Student's First Name: *

Student's Last Name: *

Student's Date of birth: *

YYYY

Social Security # *

Gender *

Female

Male

Prefer not to say

Ethnicity: Check all that apply *

American Indian/Alaskan Native

Asian/Hawaiian Native/Pacific Islander

Black/African American

Hispanic/Latino

White

Prefer not to say

Required

Is your student in Special Education? *

Yes

Does your student have a 504 plan? *

Yes

Limited English Proficiency? *

Yes

Qualifies for Free or Reduced lunch? *

Yes

Parent's Name (First & Last) *

Street Address *

City, State, & Zip Code *

Parent's phone number *

Email address *

Emergency Contact/Alternate Pick Up Person's Name *

Emergency Contact Relationship to Student *

Emergency Contact Phone Number *

Grade level for 2022-2023 *

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

Other:

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