Participant First Name *

Participant Last Name *

Gender *

Birthdate *

Disability *

Address *

City *

Zip Code *

County *

School

Parent/Guardian 1 Name *

Parent/Guardian 1 Relationship *

Parent/Guardian 1 Email *

Parent/Guardian 1 Day Phone

Parent/Guardian 1 Evening Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Relationship

Parent/Guardian 2 Day Phone

Parent/Guardian 2 Evening Phone

Parent/Guardian 2 Email

Annual Family Adjusted Gross Income *

Number of dependent children under 18 living in the home *

Ages

Number of parents living at home

Has the participant received Wonderfund before? *

How many times has the participant used Wonderfund? (N/A if Wonderfund has not been used) *

Has the participant attended Woodlands' programs before? *

How many years has the participant attended Woodlands' programs? (N/A if 0) *

Please specify the program(s) for which you are requesting Wonderfund support. *

Please indicate how much per program you can contribute. *