Programs and Services


Teen Programs:  CREW  |  HERC  |  Music  |  Summer Work 4 Change  |  Teen Café

CREW Applicant's Information
Name: Date of Birth:
Address: Apt#
City: State:   Zip:
Home Phone: Work Phone:
Email:  
Ethnicity: Languages Spoken:
Gender Male  Female  
School Attending :   School Address :

Grade Level:   Last Grade Report/Grade Average :

Do you qualify for school lunch ? Yes  No

Favorite Subject or Activity


Least Favorite Subject or Activity
Mother/Guardian 1
Name:
Address: Apt#
City: State:   Zip:
Home Phone: Work Phone:
Email:  
Did you attend College? Yes   No Name of College:
Degree Obtained: Occupation:
Father/Guardian 2
Name:
Address: Apt#
City: State:   Zip:
Home Phone: Work Phone:
Email:  
Did you attend College? Yes   No Name of College:
Degree Obtained: Occupation:
Size of Immediate Family? Taxable Income Last Year? $
AGREEMENT AND SIGNATURE
Parents and students who are enrolled in CREW must pay a one-time non-refundable enrollment fee of $150.00. Monies may also be paid in installments. (All installments must be paid prior to start of program)..

Signature of Parent/Guardian 1:    Date:

Signature of Parent/Guardian 2:    Date:



Copyright © 2009 Greater Boston Nazarene Compassionate Center, Inc. All rights reserved Design by cmsitedesign.com