Child Information Child's Level Choose an option Level I (grades K-2) Level II (grades 3-5) Level III (grades 6-8) Level IV (grades 9-12) Gender Identity Choose an option Female Male Non-binary Declined to state Other Preferred pronouns: Choose an option She He They Other What is your child's Reading Proficiency level? Choose an option Below Grade Level At Grade Level Above Grade Level Child's Race/Ethnicity Choose an option American Indian or Alaska Native Native Hawaiian or Pacific Islander Asian Black or African-American Hispanic / Latino White Other Is Your Child an English Language Learner? (English is not their first language) Type of school that your child attended this past school year: Choose an option Public Charter Private Home Other Does your child receive or qualify for free/reduced price lunch during the academic school year? lunch Has your child ever attended a CDF Freedom Schools® Summer program before? Does your child have health insurance? Has your child ever qualified for an Individual Educational Plan (IEP) or 504 plan? Choose an option Yes, IEP Yes, 504 No If yes, what is your child's health insurance carrier? Choose an option Medicaid Other N/A What are some strategies our team can use to best support your child's learning throughout the summer? (ex: needs additional reading help, prefers small groups) Does your child have any allergies or health conditions of which we should be made aware? If yes, what? Is there anything else that you would like to share about your child? Family Information Relation to Child(ren): Choose an option Parent Grandparent Other relative Other (non-relative) Is this individual a legal guardian? Gender Identity: Choose an option Female Male Non-binary Declined to state Other Preferred pronouns Choose an option She He They Other Emergency Contact Information Is this person authorized to pick up the child(ren) you enrolled in the program?
Please list other adults who are authorized to pick u the child(ren) you enrolled in the program.
In case of an emergency, I give permission for any of the above individuals to be contacted and my child(ren) may be released to any of them.
I understand that the organization that is enrolling my child(ren) in the CDF Freedom Schools® program is in partnership with the Children's Defense Fund to offer this summer program. THis personal information will be kept private and confidential and will only be shared with CDF to collect demographic information on children served and to report out this information in aggregate form.
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