EJS Project Teen Center Enrollment

EJS Project Teen Center Enrollment

Student Information

Parent/Guardian Information

Medical Information

Household Information

This section must be completed. It is necessary for the funding our organization receives. All information is entirely confidential.

Photo Release

I give my permission for EJS Project to use photos and/or videos that include my child on its social media sites and website, and in publications, printed materials and local media.


I give permission for my teen to access his/her grades and school records while in the presence of EJS staff and volunteers. I also give EJS Project and my child’s school permission to exchange information regarding my teen. The purpose of this exchange is to help both organizations more effectively support the teen’s academic goals.
Please use the space below to provide details or list educational and social-emotional goals you would like to share with us:


The following individuals are authorized to pick up my child:

By submitting this form, you give your student permission to attend EJS Project Teen’s Center and acknowledge that you have reviewed and understand the Code of Conduct regarding your student’s participation.

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