YOUTH UNITED Academic and Enrichment Center
2147 W. Manchester Ave, Los Angeles, CA 90047
323-752-1901
(office) or 323-383-8482 (info line)
Please select ALL that
apply:
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Parent/Guardian Name:
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Relationship to Child:
*
How did you hear
about us?
Child(ren)'s FIRST Name(s):
School(s) Attending:
*
Child's Age1:
Child's 1 Grade:
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Child's Age2:
Child's 2 Grade:
If for more children, include in comment section below:
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Your phone number:
*
Your email address:
Please state some brief reasons for needing services:
REGISTRATION OR INFORMATION REQUEST
For Summer, Tutoring, or
Mentoring Programs, use this form:
For Before & After-School Program, use this form:
THANK YOU FOR YOUR INTEREST! Someone will contact you soon!
* Required Field
*
Please select the
program you want to
register in or need
more information about:
*
Parent/Guardian Name:
*
Relationship to Child:
Child(ren)'s FIRST Name:
*
Child's 1 Age:
*
Child's 1 Grade:
Child's 2 Age:
Child's 2 Grade:
School(s)'s Attending:
*
Transportation Needed?
*
Your phone number:
*
Your email address:
*
How did you hear about us?
Additional information about Before /After
School and/or special requests
: