Calumet Heights Pre-Enrollment Form

Please fill out this form to receive information regarding enrollment options at CYC-Calumet Heights. We will be in touch with families as soon as spaces become available at our brand-new Center.

Name

First Name

Last Name

Phone

(###)

###

####

Child's Name

Child's Age

Additional Child's Age

Complete only if you are looking to enroll multiple children.

Does your child have any of the following special needs?

CYC provides inclusive programs and supports for children with a variety of different needs. Please check below if your child has any of the following:

Disability

Special diet

Language needs

How did you hear about us?

Any additional information you'd like to share?

Chicago Youth Centers | Where Possibility Lives

218 South Wabash Avenue, Suite 510, Chicago, IL 60604 | info@chicagoyouthcenters.org | 312-913-1700
Chicago Youth Centers (CYC) is a 501(c)(3) non-profit organization. All gifts are tax-deductible.

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Calumet Heights Enrollment Form

Calumet Heights Pre-Enrollment Form

Chicago Youth Centers

Chicago Youth Centers | Where Possibility Lives