For questions

regarding all offerings,

please contact

Demetra Jones
ForTLC,
questions
Inc.

regarding
(713)835-8361
all offerings,
or
info@tlconsultingusa.com
please contact

Demetra Jones
TLC, Inc.

(713)835-8361 or

info@tlconsultingusa.com
Return this application and
completed enrollment
summary to:

Young Womens
Return
this Preparatory
application and
College
completed
enrollment form
Academy
to:
ATTN:
After School Program
Young
Womens
1906
Cleburne
Street

CHILD INFORMATION

Please complete a separate application for each child enrolling in the YWCPA After-School Program.
_________________________________________________________________________________________________________________
Student Name
Age
Birth Date
_________________________________________________________________________________________________________________
Address
City
State
Zip
_________________________________________________________________________________________________________________
Entering Grade Level (As of August 2011)

PARENT/GUARDIAN
_________________________________________________________________________________________________________________
Parent or Guardian
_________________________________________________________________________________________________________________
Work Phone
Home Phone
Cell Phone
_________________________________________________________________________________________________________________
Address (if different from above)
E-mail address
_________________________________________________________________________________________________________________
Parent or Guardian
_________________________________________________________________________________________________________________
Work Phone
Home Phone
Cell Phone
_________________________________________________________________________________________________________________
Address (if different from above)
E-mail address

MEDICAL INFORMATION/PERMISSION TO TREAT

_________________________________________________________________________________________________________________
Physician
Phone

Houston,
TX 77004
College
Preparatory

_________________________________________________________________________________________________________________
Dentist
Phone

ATTN:

_________________________________________________________________________________________________________________
Medical Insurance Company
Policy Number

Academy

After-School Program
1906 Cleburne Street
Houston, TX 77004

_________________________________________________________________________________________________________________
Please list any allergies and conditions of which YWCPA After-School Programs should be aware:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Emergency Contact
Relationship
Phone
When neither I nor the emergency contact listed above can be reached, I give my consent and
permission for the above-named doctor to provide medical attention to my child. In the event that the
doctor listed above cannot be contacted or in the event of an emergency, I give any licensed physician
dentist, hospital or other health care provider consent to perform emergency medical treatment
deemed necessary for the well-being of my child at my expense. This may include transportation to
the nearest emergency room.
I have read and agree to the TLC, Inc. YWCPA After-School Program Policies.
_________________________________________________________________________________________________________________
Parent/Guardian Signature
Date

AFTER-SCHOOL PROGRAM ENROLLMENT FORM

Fall 2011 After-School Program Registration Begins July 18, 2011
Young Womens

College Preparatory
Academy

After-School Program
Provided by

Training and

Leadership Consulting,
Inc.

Sports

Lacrosse

Golf

Aquatics

Volleyball
Speech

Speech/Interpretive Speaking

Debate

For questions

regarding all offerings,

please contact

Demetra Jones
TLC, Inc.

(713)835-8361 or

info@tlconsultingusa.com
www.tlconsultingusa.com

AFTER

Fine Arts

Violin/Strings

Piano

Theater

SCHOOL PROGRAM OFFERINGS

Young Womens

College Preparatory

*Partial listing of classes

CompuKids: All About Computers

Academy

Cheerleading (One! Two! Three! Cheer!): The cheerleading program offers the basics in cheer
exercises.

Provided by

Express Yourself! - Artsy and Craftsy: General Arts programs are designed for students who wish to
explore a variety of arts areas. With several classes to choose, General Arts students can put more
emphasis on a particular area, or experience many different art forms.

After School Program

Training and

Leadership Consulting,
Inc.

Lets Dance!: The dance program offers a curriculum designed for students who wish to study jazz,
ballet, tap and modern dance. All classes provide a positive, focused, professional atmosphere.
Music Mania: TLC offers a wide range of music programs for talented youth musicians. The programs
focus on individual and group performances.
Robotics: The robotics program is an outstanding way to introduce the young scientific mind to the
future opportunities of a high-technology world. Our hands-on approach, along with lectures,
videotapes and demonstrations is designed to spark the interest of the future scientists and engineers
of our country.

For questions

So, You Want to Be An Actor! Theater Arts: Theater programs are available for students who express
an avid interest in the theater. The program will include musical theatre, design and technology,
repertory theatre, acting, and more.

please contact

Fun with Visual Arts: Students receive individualized instruction, visual arts courses covering issues
of design, and art history. Visual Arts students gather as a group to discuss aesthetics, presentations,
artists reviews and more.

TLC, Inc.

Wacky Writing: The writing program will focus on two major themes: first, building the desire and
confidence to write, and second; giving children the tools with which to accomplish the task. Students
will learn to write poetry, science fiction, mystery and much more. Parents will be invited to share in
the writing experiences on Fridays and the children's work will be on display at
that time. Students will be given at home assignments to enhance the learning experience.

regarding all offerings,

Demetra Jones
(713)835-8361 or

info@tlconsultingusa.com
www.tlconsultingusa.com

Girls Lacrosse: Aimed at teaching girls proper techniques, fundamental skills, drill and form needed
to successfully compete in lacrosse.
Volleyball: Youth will learn how to set, serve and pass competively in the game of volleyball.

Cambria