Prime Time Palm Beach County

Home | Contact Us | Career Center | Site Index | Login | Registration

What's Happening
Event Registration
Lights on Afterschool
Home > What's Happening >
Member Registration
?? Registration
To register with PrimeTime PBC please fill out the form below.
Name of Organization:
Mailing Address:
City:               State:                   Zip: 
Main Phone Number:            Fax Number:  
Type of Organization (check all that apply):
CBOSafe SchoolBeaconFor Profit
County/GovmtResource AgencySACCOverlay Provider
Childcare CenterNon-ProfitOther  
Licensure: Yes         No         Exempt
Website (If Applicable):
Funding Sources (mention all that apply to the organization): 
Number of Children Enrolled (by Grade):   K-5:       6-8:       9+: 
Daily Attendance (As of Last Day of School or during Summer Camp):  
Number of Full Time Staff Members:       Number of Part Time Staff Members: 
Days and Hours of Operation:
Monday: to Tuesday: to
Wednesday: to Thursday: to
Friday: to Saturday: to
Sunday: to
Do you have a Summer Camp Program?    Yes         No
If Yes, Number of youth enrolled: 
Summer Camp Days and Hours of Operation:
Monday: to Tuesday: to
Wednesday: to Thursday: to
Friday: to Saturday: to
Sunday: to
Contact # 1 (Required)
     First Name:        Middle Initial:        Last Name: 
Cell Number:        Direct Office Line: 
Title:         E-mail Address: 
Contact Type:
Full Time Part Time Other
Education Level:
High School/GED 2 Year College 4 Year College Graduate Courses
CDA 40 Hour Certificate 120 Hour School Age Certificate
Program Name:
Contact # 2
     First Name:        Middle Initial:        Last Name: 
Cell Number:       Direct Office Line: 
Title:         E-mail Address: 
Contact Type:
Full Time Part Time Other
Education Level:
High School/GED 2 Year College 4 Year College Graduate Courses
CDA 40 Hour Certificate 120 Hour School Age Certificate
Program Name:
Contact # 3
     First Name:        Middle Initial:        Last Name: 
Cell Number:       Direct Office Line: 
Title:         E-mail Address: 
Contact Type:
Full Time Part Time Other
Education Level:
High School/GED 2 Year College 4 Year College Graduate Courses
CDA 40 Hour Certificate 120 Hour School Age Certificate
Program Name:
Login Information
Username:
Password:
Confirm Password:

Please review all information before clicking the button below.    

   
    

   

     

 

Upcoming Events

Afterschool Consortium Networking Event

 

October 8, 2008

Special Presentation

Children's Service Council

10:00 a.m.


Click here to register

 

 

DISCOVER AFTERSCOOL

FAMILY FUN FAIR!!

Click here for more information!

 

 

 

Click on logo to "Join Now" 

 

 

Quick Links
Contact Us
Online Forms
Enhancements
Lending Library
Event Registration
Scholarship Application
Edit Member Information