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Stay Safe - Online Program

Student First Name *

Student Last name *

Student Birth Date *

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Parent Contact & Billing Information:

Parent First Name *

First

Parent Last name *

Last

Address (street address, town, city, zip) *

Home Ph:

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Cell:

Email *

Other Emergency Contact:

Emergency Contact name *

Phone *

Email *

Special Needs or Considerations:

Program Interest *

REACH

CLP

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ASAT/CHW

Name of class student is applying for: *

Currently enrolled in high school or post-secondary program? If yes, please list school: *

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Chapel Haven Programs

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Upcoming Events

Join us Saturday, Oct. 30 for our virtual open house

Join us for our first in-person open house since pandemic, set for Sept. 11

Seventh annual golf tournament coming up Sept. 28, register your foursome and join us!

Fill out this form to sign up for classes!

Fill out this form to sign up for classes!

Fill out this form to sign up for classes!

Fill out this form to sign up for classes!

Fill out this form to sign up!

Fill out this form to sign up!

Fill out this form to sign up!