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 *
School *
For Term Applying
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 Term Applying
Birthdate *
MM
/
DD
/
YYYY
Adult T-Shirt Size *
Ethnicity
Race
Select all that apply
Please list any allergies or medical conditions that we should be aware of.
How did your family hear about Loveworks?
Comments/Notes
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 *
Primary Contact Last Name *
Relation to Student *
Cell or Primary Phone Number *
Primary Email Address *
Street Address *
City *
State *
Zip Code *
Second Parent / Guardian Contact Information
First Name
Last Name
Relation to Student
Cell or Primary Phone Number
Email Address
Third Parent / Guardian Contact Information
First Name
Last Name
Relation to Student
Cell or Primary Phone Number
Email Address
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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