Request edit access
Einstein's Playground CDF Freedom School Child Enrollment Form
Complete an enrollment form for each child.
Email address *
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Birth Date *
MM
/
DD
/
YYYY
Child's Age
Your answer
Home Street Address (City, State, Zip Code) *
Your answer
Einstein's Playground CDF Freedom School Site *
T-Shirt Size *
Gender Identity *
Preferred Pronouns: *
Child's Race/Ethnicity (check all that apply) *
Is your child an English Language Learner? (English is not their first language)
Please list any languages your child speaks at home. *
Your answer
Type of school that your child attended this past year: *
Grade just completed: *
Does your child receive or qualify for free/reduced price lunch at school during the academic school year? *
Child's School Name *
Your answer
Does your child have health insurance? *
If yes, what is your child's health insurance carrier? *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service