Enrollment

Skip to main content

Summer Program: Enrollment Now Open

Programs
Before & After School Program
Youth Recreation Program
Summer Recreation Program
Daycare Program
About Us
About
Our History
Contact

Programs
Before & After School Program
Youth Recreation Program
Summer Recreation Program
Daycare Program
About Us
About
Our History
Contact

2025-2026 SCHOOL YEAR APPLICATION

WATERVLIET CIVIC CENTER BEFORE & AFTER SCHOOL PROGRAM

Child Information

Childs Name

*

Childs Cell #

*

Street Address

*

Address

City

*

Zip Code

*

Date of Birth

MonthDayYear

Grade in Sept.

Guardian Information

Parent/Guardian's Name

Cell #

*

Parent/Guardian's Home #

*

Parent/Guardian's Work #

*

Street Address

*

Address

City

*

Zip Code

*

Guardian Information

Parent/Guardian's Name

Cell #

Parent/Guardian's Home #

Parent/Guardian's Work #

Street Address

Address

City

Zip Code

Emergency Contact 1

Name

*

Cell #

*

Emergency Contact 2

Name

Cell #

Submit

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Footer

Main Office:
102 14th Street
Watervliet, NY 12189

Phone:
(518)273-5922

Email:
livetheciv@gmail.com

Pages

Programs

Before & After School Program

Youth Recreation Program

Summer Recreation Program

Daycare Program

Join Our Mailing List

Label

Subscribe

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

© {{year}} Copyright. All Rights Reserved.

Terms & Conditions