Apply Online

Welcome to BCC Out of School Time! Our enrichment services instill academic excellence and positive life choices, promotes self-sufficiency and provides enhanced cultural, social and recreational activities for K-12th grade students in year round programming. We also deliver services to children and families in, health, financial stability and family well-being while engaging parents as partners every step of the way.

Parent means an Out of School Time child’s mother or father, other family member (who has legal guardianship), who is a primary caregiver, foster parent or authorized caregiver, guardian or the person with whom the child has been placed for purposed of adoption pending a final adoption decree.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender

Email Address (Required)

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race

Hispanic

English Proficiency

Other Language

Employment Status

Child's Relationship

Is your family experiencing homelessness?

Living Address (Required)

Address Line 2

City (Required)

State (Required)

ZIP (Required)

Click here to find a provider in your area.

Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

Is there another parent or legal guardian in the household whose income supports the child?

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Email Address

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race

Hispanic

English Proficiency

Other Language

Employment Status

Child's Relationship

Provides Financial Support

Family means all personal living in the same household who are supported by the child's parent(s) or guardian(s) income; and are related to the child's parent (s) or guardian (s) by blood, marriage, or adoption; or are the child's authorized caregiver or legally responsible party.

Number of Parents/Guardians

Primary Language at Home

Number in Household

Gross Annual Income

This application is used for NEW applicants. If you have completed an application for this child previously, please contact Georgett Johnson at gjohnson@bethlehemcenter.org to follow up.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Primary Health Coverage

Does your child have a disability or do you have any concerns about your child's development?

Is there anything else you want to tell us about your child?

Which program are you applying for? (Required)

1st Location Preference

2nd Location Preference

- Your Address - Available Locations

Click a location on the map to see more info

Click here to find a provider in your area.

Do you want to apply now for another child in your family?

Add Another Applicant

Are there other children in the family?

Add a Sibling

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings