Enrollment Form

Yay! We are so excited for this adventure with you!

Child's A's Name

First Name

Last Name

Birthdate

Child B's Name (if applicable)

First Name

Last Name

Birthdate

Grown Up A's Name

Mailing Address

Phone Number

(###)

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Relationship to the child/ren

Grown Up B's Name (if applicable)

Mailing Address

Phone Number (if applicable)

(###)

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Relationship to the child/ren

Permissions

Grown Up C's Name (if applicable)

Mailing Address

Phone Number (if applicable)

(###)

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Relationship to the child/ren

Permissions

Which address do you want the materials sent to?

Grownup 1

Grownup 2

Grownup 3

Do your children have access to internet in all the home(s) they live in?

Do each of your children have access to a device to access the internet? If so, what type of device?

Times for Grownup 1:1

Times for Grownup and Kid 1:1

Is there anything you want to share about your family's culture or identity? For example, languages spoken or signed, gender pronouns, family structure, racial or ethnic identity, religions observed, and so on.

Is there anything else you want us to know?