Einstein's Playground CDF Freedom School Child Enrollment Form
Complete an enrollment form for each child. Each enrolled child will be entered into the lottery that will take place in March (all parents will be invited).
Email address *
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Birth Date *
MM
/
DD
/
YYYY
Child's Age *
Your answer
Home Street Address (City, State, Zip Code) *
Your answer
Einstein's Playground CDF Freedom School Site *
T-Shirt Size (*these are children sizes) *
Gender Identity *
Preferred Pronouns: *
Child's Race/Ethnicity (check all that apply) *
Is your child an English Language Learner? (English is not their first language) *
Please list any languages your child speaks at home. *
Your answer
Type of school that your child attended this past year: *
Grade just completed: *
Does your child receive or qualify for free/reduced price lunch at school during the academic school year? *
Child's School Name *
Your answer
County Your Child's School is located in *
Your answer
Does your child have health insurance? *
If yes, what is your child's health insurance carrier? *
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