CAN Educational Program Registration Form

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Thank you for considering enrolling your child or children into CAN's Educational Programs. These programs include:
  • CAN After School (or Out-of-School) Programs (Grades K-12)
  • CAN Educational Summer Programs (Rising K-6 at most locations)
  • CAN YouthWorks Program (Ages 14-18)

Completing this form does not guarantee that your child or children are registered in our programs (due to a variety of factors including funding source restrictions, eligibility requirements, etc.).

Once this registration form is reviewed, you will receive a notification that will officially confirm your child or children have been enrolled with more program details, or an explanation as to why he, she, or they have not been enrolled.

The registration includes the following (Click "Submit" to head to the next form until the end):
  • General Household Information
  • Release of Information Waiver
  • Client Rights & Responsibilities Waiver
  • Field Trip and Activity Permission Slip
  • Liability Waiver
  • Media/Photo Release Form (optional)
The demographic information requested is for grant-writing purposes so we can continue to fund our free programs for children & youth.
Location Information

Primary Parent/Guardian Information
Please complete the information for yourself. For existing Families, your Primary Parent/Guardian is already listed.  To update your Household's Primary Parent/Guardian, please contact CAN at 734-994-2985.

Include Apartment or Unit Number separated by a comma

Select multiple languages by holding Ctrl or Command.

No "$" sign or comma/decimals - it is okay to round up or round down.

Emergency Contact Information

Please provide updates to your existing Emergency Contacts by modifying address or phone.  Please do not click the Remove button in this section, use the Status field instead to indicate if an Emergency Contact is Inactive.

Sample: 1234 Practice Lane, Ann Arbor, MI 48108

Sample: 1234 Practice Lane, Ann Arbor, MI 48108

Insurance Information (Optional): This information will help CAN staff accompanying your child to have your insurance and medical information in the case of an emergency, in addition to Emergency Contacts if we can't get a hold of you. If possible, please provide the following:

Child Information
Please complete this information for your child. If you have more than one child, please select "Add another response" at the bottom of this section to add information about another child. You may add as many responses as you need to include all of the children you are registering for a program.

Existing Families: Details for anyone in your household between the ages of 5-18 will be listed automatically.  You will also see adults if we do not have their Date of Birth.  If that's the case, update their Date of Birth and select "Click here to NOT register this individual for upcoming programs" to rectify the issue.

Select multiple languages by holding Ctrl or Command.

If summer, the grade child will be in the next school year

Check all that apply.

If no, type None or N/A

If no, type None or N/A
(Optional) In the case of an emergency, we will take your child to seek proper medical care. It helps CAN staff accompanying your child to have their doctor/dentist's name and phone number in the case of an emergency. If possible, please provide the following: