Washington Dugsi Association

Student Enrollment Application

Thank you for your interest in Washington Dugsi Association. Please complete the form below to apply for enrollment in our youth programs.

Student Information

Student Full Name*

Date of Birth*

Age*

Grade*

Current School*

Parent / Guardian Information

Parent/Guardian Full Name*

Phone Number*

Email Address*

Home Address*

City*

ZIP Code*

Program Selection

Select all programs you are interested in.

After-School Program

Weekend Dugsi Program

Tutoring Support

Youth Mentorship

Sports Program

Emergency Contact

Full Name*

Relationship to Student*

Phone Number*

Medical / Special Information

Allergies, Medical Conditions, or Accommodations

Parent Agreement

I understand that submission of this application does not guarantee enrollment and agree to follow all Washington Dugsi Association policies and guidelines. *

Parent/Guardian Digital Signature*

Sign here

Draw your signature above using mouse or touch.

Date

Washington Dugsi Association is a 501(c)(3) nonprofit organization.

info@wadugsi.org·(253) 347-4981