Loveworks Afterschool Leadership Application - Norman
Page 1 - Parent and Student Information
This page is to be completed by a parent or guardian and will provide Loveworks with contact information for parents and basic information about the student applying.
Student Information
Student Name *
Your answer
School *
For 2018-2019 academic year
Loveworks Programming Days *
Students attend Loveworks Afterschool Leadership at the Loveworks Center (151 12th Ave SE, Norman, Ok) from after-school to 6:00pm twice per week. Please select which set of days you wish to apply for.
Student Grade Level *
For 2018-2019 academic year
Birthdate *
MM
/
DD
/
YYYY
Ethnicity
Race
Select all that apply
Please list any allergies or medical conditions that we should be aware of.
Your answer
How did your family hear about Loveworks?
Your answer
Comments/Notes
Your answer
Parent or Guardian Information
Below please provide the contact information for the parent or guardian who will be our primary point of contact.
Primary Contact First Name *
Your answer
Primary Contact Last Name *
Your answer
Relation to Student *
Your answer
Cell or Primary Phone Number *
Your answer
Primary Email Address *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Second Parent / Guardian Contact Information
First Name
Your answer
Last Name
Your answer
Relation to Student
Your answer
Cell or Primary Phone Number
Your answer
Email Address
Your answer
Third Parent / Guardian Contact Information
First Name
Your answer
Last Name
Your answer
Relation to Student
Your answer
Cell or Primary Phone Number
Your answer
Email Address
Your answer
Page 1 - Parent and Student Information Completed
The next page will include a set of application questions to be answered by the student applying. Press Continue to move on to page 2
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