Titusville 21st Century Community Learning Center
Enrollment Forms

For your convenience, enrollment forms are available for printing from the links listed below. Application forms are also available at Main Street, Hydetown, and Pleasantville elementary schools and the Titusville Middle School. Additionally, enrollment applications can be picked up at the Titusville YMCA. All completed enrollment applications must be returned to the Titusville YMCA, not the individual schools. Submitted enrollment applications will be reviewed and you will be notified after we have processed your application. Incomplete sections or missing forms can result in a delay of the processing of your application. If you have any questions, e-mail us at:

Titus21century@aol.com (fastest response), or call us at 827-3931.

Enrollment forms:
These forms require Adobe Acrobat Reader to open. If you do not have Adobe Acrobat Reader, click here.To print forms make sure to hit the adobe print button (highlighted in red.)pb

Introduction Form and Fee Information(Important- Please read)

Main Application Page

Child Health Assessment Form
(REQUIRED within 30 days of enrollment for all children through age 12.) 

Behavior Policy Form

School Information Release Waiver

Program Fees

Financial Assistance


 Titusville Pennsylvania YMCA
21st Century Learning Center


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