Child Enrollment Form

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Child Enrollment Form

Program Dates: July 3-August 5 | 8:30 am - 3:30 pm

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Email *

Child Information

First Name *

Child's first name

Last Name *

Child's last name

Birthdate
*

Child's birthdate

MM

/

DD

/

YYYY

Gender Identity *

Child's gender identity

Male

Female

Non-binary

Decline to state

Other

Preferred Pronouns *

Child's preferred pronoun

He

She

They

Other

Assigned Level *

Level I (grades K-2)

Level II (grades 3-5)

Level III (grades 6-8)

Level IV (grades 9-12)

Freedom School Site *

Name of the local program site.

DC Dream Center (1st-5th grades, including rising 6th graders)

Social Justice School (6th-8th grades)

Required

American Indian or Alaska Native *

Choose 1 if your child identifies with this race/ethnicity. Choose 0 if not.

1

0

Asian *

Choose 1 if your child identifies with this race/ethnicity. Choose 0 if not.

1

0

Black or African-American *

Choose 1 if your child identifies with this race/ethnicity. Choose 0 if not.

1

0

Hispanic/Latino *

Choose 1 if your child identifies with this race/ethnicity. Choose 0 if not.

1

0

Native Hawaiian or Pacific Islander *

Choose 1 if your child identifies with this race/ethnicity. Choose 0 if not.

1

0

White *

Choose 1 if your child identifies with this race/ethnicity. Choose 0 if not.

1

0

Other Race/Ethnicity *

Choose 1 if your child identifies with a race/ethnicity that was not listed above. Choose 0 if not.

1

0

Type of School Attended *

Type of school your child attended in the 2022-2023 school year.

Public

Charter

Private

Home

Other

Grade Just Completed *

What is the grade they're currently in?

Free or Reduced Lunch *

Does your child eligible to receive free/reduced price lunch at school during the academic school year?

Child is eligible

Child is not eligible

School Name *

School City *

School State *

Special Education or had a 504 plan? *

Has your child ever qualified for an Individual Educational Plan (IEP) or 504 plan?

IEP

504

No

Reading Proficiency Level *

What is your child’s Reading Proficiency level?

Below Grade Level

At Grade Level

Above Grade Level

Language(s) Spoken at Home *

Please list any languages your child speaks at home.

English Language Learner *

Is your child an English Language Learner? (English is not their first language)

Yes

No

Health Insurance *

Child has health insurance

Child does not have health insurance

Health Insurance Carrier *

What is your child’s health insurance carrier?

Medicaid

Other

N/A

Attended a CDF FS Summer program before? *

Has your child ever attended a CDF Freedom Schools® Summer (or After-School) program before?

Yes

No

How many summers has child participated? *

How many years has the child participated in the program? Count both Summer years and any After-School years.

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