Student Enrollment Form

Please complete the form below. Required fields marked with an asterisk *

Do you have access to the internet and either a tablet or a laptop/computer so you can access Google classroom on a regular basis

In order to participate in the program at YABC you must have access to the internet and either a tablet or a laptop/computer so you can access Google classroom on a regular basis.

Answer required for "Do you have access to the internet and either a tablet or a laptop/computer so you can access Google classroom on a regular basis"

Yes-I have access to a tablet/laptop/computer and access to the internet

I do not have access to a tablet/laptop/computer and do not have access to the internet. (I will submit my application when I have access.)

Student Contact Information

Student ID Number*

Answer required for "Student ID Number"

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Date of Birth*

Answer required for "Date of Birth"

Student Street Address*

Answer required for "Student Street Address"

Student City, State and Zip Code*

Answer required for "Student City, State and Zip Code"

School Email*

Answer required for "School Email"

Personal Email 2*

Answer required for "Personal Email 2"

Mobile Phone*

Number Required

Parent/Guardian Name*

Answer required for "Parent/Guardian Name"

Parent/Guardian Email Address*

Answer required for "Parent/Guardian Email Address"

Parent/Guardian Phone*

Number Required

Name of your Home School*

Answer required for "Name of your Home School"

Name of your Home School Counselor*

Answer required for "Name of your Home School Counselor"

Home School Counselor Email Address*

Answer required for "Home School Counselor Email Address"

Will you attend DBK YABC full-time or as night school after your day school (shared instruction)?*

Answer required for "Will you attend DBK YABC full-time or as night school after your day school (shared instruction)?"

Full-Time: I do not attend school during the day

Shared Instruction: I am an 11th or 12th grader who attends school during the day and would like to take classes at DBK YABC in the evening

How many days a week would you like to attend classes? *

All courses, except physical education, and NX courses, are scheduled for Monday and Wednesday or Tuesday and Thursday. A student may be scheduled for PE and NX courses 1 day per week.

Answer required for "How many days a week would you like to attend classes? "

I would like to attend classes 4 days per week

I would like to attend 2 days per week and don’t have a preference on which days I attend classes.

I prefer classes on Monday and Wednesday, but it’s ok if my schedule is on Tuesday and Thursday.

I prefer classes on Tuesday and Thursday, but it’s ok if my schedule is on Monday and Wednesday

I can only attend classes on Monday and Wednesday.

I can only attend classes on Tuesday and Thursday.

Why do you want to be a part of Downtown Brooklyn YABC?*

Answer required for "Why do you want to be a part of Downtown Brooklyn YABC?"

Do you have any questions?

Answer required for "Do you have any questions?"

Please fix the highlighted areas below before submitting.

Student Enrollment Form