Student Scholar Enrollment Form

July 1st 2024 - August 9th, 2024
Holiday Break: July 4-5
(Scholars must commit to the entire 6-week program)

Email

Student's First Name

Student's Last Name

Student's Birthdate

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Student's Level

Level 1 (Grades K-2)

Level 2 (Grades 3-5)

Student's Gender

Student's Preferred pronoun

Student's Reading Level

Below Grade Level

At Grade Level

Above Grade Level

Please list any languages your child speaks at home

Is your child an English Language Learner? (English is not their First Language)

Yes

No

School Name

City of School

State of School

Does your child receive or qualify free/reduced price lunch at school during the academic year?

Yes

No

Has your child ever attended a CDF Freedom Schools Summer or After-School program before?

Yes

No

If yes, how many years has your child participated in the CDF Freedom Schools Program?

Does your child have health insurance?

Yes

No

If yes, what is your child's health insurance carrier?

Medicaid

Other

N/A

Has your child ever qualified for an Individual Education Plan (IEP) or 504 plan?

IEP

504

N/A

What are some strategies our team can use to best support your child's learning throughout the program? (ex: needs additional reading help, prefers small group)

Allergies

Is there anything else you would like to share about your child?