RSVP 1 — BROTHAS INC. Youth Initiative

Project Surge

The definition of surge is to increase suddenly and powerfully.

Come join Brothas Inc as we increase our parameters and outreach both “SUDDENLY” and “STRONGLY” through our after school program.

Beginning March 19, 2025, we will be offering 2 hours of RECREATION and EDUCATIONAL enrichment to area children grades 5 through 12. Join us on Mondays and Wednesdays from 3:30 - 5:30.

Please complete the following registration form and join us for orientation on March 17, 2025.

Child's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

Age

Race

African American

Caucasian

Latino

Other

Gender

Male

Female

Other

Name of School

Grade

Parent/Guardian's Name

First Name

Last Name

Phone

(###)

###

####

Emergency/Alternate Contact

First Name

Last Name

Emergency/Alternate Phone

(###)

###

####