F.O.C.U.O.S. You are the Prize.

Register with F.O.C.U.O.S.

Complete The Participant Registration Form Below:

Participants Name

Participants Date of Birth

Age

Participants Gender

Male

Female

Parents/Guardian Name if

Phone Number

Email (Parent/Guardian)

Address

Emergency Contact Name & Number If Guardian Cannot Be Reached

Allergies

Yes

No

Provide Allergies If Above answer is Yes

Medication / List of Medication if applicable

Special Instructions

Income Level

Low

Med

High

Which Program are you interested in

F.O.C.U.O.S ON THE SUCCESS ACADEMY Weekly Tutoring

F.O.C.O.S On Horizon 9-15

F.O.C.U.O.S. on the Prize 12-18 Intervention Program

F.O.C.U.O.S ON THE FUTURE 16-24

F.O.C.U.O.S ON THE OUTLOOK Re-Entry Program

Community Service

Not Sure

Message: