IFSP - 2019 Child Enrollment Form
2019 Summer Program Dates: June 17 - July 26

Mandatory Parent/Family Orientation: Thursday, June 13 at 6:30pm at All Souls Unitarian Church
Site Selection *
Child Information
In the below section, please provide the appropriate information for the child you are enrolling.
Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Age *
Street Address *
Your answer
City *
Required
State *
Required
Zip Code *
Your answer
Gender *
T-Shirt Size *
Preferred Pronoun *
Race/Ethnicity *
Required
Language(s) Spoken *
Your answer
Is your child an English Language Learner? *
Select Yes if you child's first language is not English
Type of school your child attended this past year *
Current Grade (2018-2019 school year) *
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?
Has your child ever participated in Special Education or had a 504 plan? *
Has your child ever attended a CDF Freedom Schools® Summer program before? *
If yes, how many years has your child participated in the CDF Freedom Schools summer program?
What are some strategies our team can use to best support your child's learning throughout the summer?(ex: positive reinforcement, small groups)
Your answer
Does your child have any allergies or health conditions of which we should be made aware? If yes, what? *
Your answer
Is there anything else that you would like to share about your child?
Your answer
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