ENROLLMENT INFORMATION

If you are interested in registering your child for one of our programs, please send in a request by filling out the forms below and we will reach out with next steps on how to register your student if we have availability.

Parent/Guardian's Name

First Name

Last Name

Phone

(###)

###

####

Student's Name

Student's Grade

Student's School

I would like more information on enrolling my child in:

Additional Comments

904.359.5437 | champion@malwashington.com
1055 W. 6th Street | Jacksonville, FL 32209

The MaliVai Washington Youth Foundation is a nonprofit 501(c)(3) tax-exempt organization.
EIN 59-3559150

ENROLLMENT INFORMATION

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