Discovery Day – November 2024

Child's full name: *

Child's age: * 6 7 8 9 10 11 12

Parent/guardian's full name: *

Email: *

Phone: *

Does participant have any allergies? (if yes, please list): *

Does your family qualify for the Free/Reduced Lunch Program?: * Yes No

For grant reporting purposes, please indicate the child's ethnicity (optional): * American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White/Caucasian Other (Specify below)

Other (specify):

For grant purposes only, how many members are in your household?: *

For grant purposes only, what is your household's yearly income?: *

What is your zipcode?: *

Terms and Conditions (See link below): * I agree

Privacy Preference:   Opt-out from being displayed in the public list of attendees.