Rooted at the ROCK Summer Learning Lab
Sign in to Google to save your progress. Learn more
For which summer site is this student being registered? *
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
What is the student's gender? *
How does the child identify racially? *
Does the child identify as Latino/Latina/LatinX/Hispanic *
Does the family believe the child will qualify for free or reduced lunch? *
What is the student's street address? (Note: If a child is homeless please indicate by typing "Homeless" in this box.) *
In what city does the student live?
What is the student's zip code? *
What grade will the child have completed on June 15, 2022? *
Does the child have an IEP, 504 Plan, special need, or identified disability? *
What is the parent/guardian's first name? *
What is the parent/guardian's last name? *
What is the parent/guardian's phone number? *
What is the parent/guardian's email address? (Example: info@enrollindy.og) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Rooted School--Indianapolis. Report Abuse