Please be advised, upon filling out this form, you are automatically added to our list.  You will not receive a confirmation email

After clicking the SUBMIT button, if your screen reads "Your child is on our Waiting List!", you've made it! 

We will contact you if your child meets the needs of a potential opening.

We are currently fully enrolled through the 2017-2018 school year.  

Child's Name *
Child's Name
Child's date of birth *
Child's date of birth
Please check all boxes boxes that apply. (Optional: Nia House does not discriminate on the basis of race, color, national origin, sex, religion, gender, sexual preference or ability.)
Parent Name *
Parent Name
Parent Name
Parent Name
Address *
Phone *
If you plan to apply for a scholarship, provide your family's gross income. If you are not applying for a scholarship, feel free to enter $0.
Start date *
Start date