Remnant Youth Program Enrollment Form

Student First Name

Student Last Name

Parent/ Guardian First Name

Parent/ Guardian Last name

Second Parent First and Last Name (optional)

Student Date Of Birth

Month

Day

Year

Student Current Grade Level

Current Schooling Model

Parent Email

Parent Phone

City/ Area

I would like to enroll my student in the following Program(s):

Remnant Leadership Academy (Grades 6-12) - Fridays **Starting August 7** = $240/ month

Remnant Kids (Grades K-5) **Starting August 5** = $240/ month

3x3 Basketball Play Lab (Grades 4-8) - Thursdays 10:00am - 2:00pm = $240/ month

School Year

2026 - 2027 (August)

Additional T-shirt(s)

Please Note: Remnant t-shirts are our required uniform. Your first shirt is included with registration at no extra cost. If you'd like extra shirts for family members or backups, they're available in our shop for $25 each.

Method of Payment

STEP UP Scholarship

Self-pay

Remnant Youth Program Enrollment Form

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