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T.R.E.E. Foundation Student Enrollment Form
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Date
*
Which program you are enrolling into?
*
After-School Program
Summer School Program
Literacy Program
Parent-Engagement Program
S.T.E.A.M. (Science, Technology, Engineering, Art, and Math)
Child's Name
*
First
Middle
Last
Child's Birth Date
*
Child's Age
*
Child's Gender
*
Male
Female
Address
*
City
*
State:
*
Zip Code
*
Child's Race/Ethnicity (Check all that apply)
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Asian
Black or African-American
White
Other
Is your child an English language learner?
*
Yes
No
Please list any language your child speaks at home.
*
Type of school your child attended this past school year:
*
Public
Charter
Private
Home
Other
Grade child in now:
Does your child receive or qualify for reduced lunch price at school during the academic school year?
*
Yes
No
Child's School:
*
City:
*
State:
Does your child have health insurance?
*
Yes
No
If yes, what is your child's health insurance carrier?
*
Has your child ever participated in Special Education or had a 504 Plan?
*
Yes, Special Ed
Yes, 504
No
Has your child ever attended a T.R.E.E. Foundation summer program before?
*
Yes
No
If yes, how many years has your child participated in the T.R.E.E. Foundation summer program?
What are some strategies our program can use to best support your child's learning throughout the summer? (Ex: positive reinforcement, small groups)learning
Does your child have any allergies or health conditions which we should be made aware of? If yes, what?
*
Is there anything else that you would like to share about your child?
Your child's t-shirt size?
*
Name of adult completing this form:
*
First
Middle
Last
Relation to the child:
*
Parent
Grandparent
Other relative
Guardian
Other
Gender:
Male
Female
Home Phone Number:
Cell Phone Number:
*
Work Phone Number:
Email
*
Alternate Email (If applicable)
How many people live in your household?
*
# of children ages 6-18 years old:
*
# of children 5 years old and under:
*
Emergency Contact's Name:
*
First
Last
Is this emergency contact person authorized to pick up the child you enrolled in the program?
*
Yes
No
Emergency contact's home phone#:
Emergency contact's cell phone#:
*
Emergency Contact's Email:
*
List other adults, their relationship to the child and their cell phone number who are authorized to pick up the child you enrolled in the program:
*
In case of an emergency, I give permission for any of the adults who I listed on this form as authorized to pick up the enrolled child to be contacted and released to any of them.
Parent/Other Adult Caregiver Signature:
Date:
*
I understand that T.R.E.E. Foundation is enrolling my child in the program in partnership with community organizations to offer this summer program. This personal information will be kept private and confidential and will only be shared to collect demographic information on children served and to report out this information in aggregate form.
Parent/Guardian Signature:
Date:
*
Submit
***Email completed and signed form to lashanda.davis@treefoundtexas.net***
The student’s latest report card must be submitted with this application.
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