OST Enrollment Survey — Chicago Youth Centers

Name

First Name

Last Name

Phone

(###)

###

####

Email

Address

Child's Name

Child's Age

Additional Child's Name

Complete only if you wish to enroll multiple children.

Additional Child's Age

Only complete if you wish to enroll multiple children.

Which CYC location do you wish to enroll your child at?

How did you hear about us?

Any additional information you would 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.