Kansas City CDF Freedom Schools® Saturday Reading Academy Enrollment 2016-17
All fields are required and must be completed.


*PLEASE NOTE: In order for your child to attend the Tutoring Program, you (the parent/guardian) must attend Parent Orientation, and Parent Workshops. This check means you understand.
SCHOLAR INFORMATION




Student Number:
Child's First Name: *
Child's Middle Name *
Child's Last Name: *
Preferred or Nickname: *
Date of Birth:
*

Gender:
MaleFemale



Child's Address: *
City: *
State:
Zip: *





Your Name:
Relationship to Child: *

How did you hear about the CDF Freedom School® programs?
DEMOGRAPHICS

Race/Ethinicity : *
If Other, please specify
Total number living in your household: *
Children in Household: *
Household Income : *
2016-2017 Grade Level: *
Name of Current School: *
Type of School: *
Name of Current Teacher: *
School Attending in Fall: *



Current School District: *

1. Do any of your children receive free/reduced price lunch at school during the school year?

YesNo

2. Has this child ever repeated a grade?

YesNo

3. Was the child in special education during the current or previous school year?

YesNo

4. Has this child attended a CDF Freedom Schools® program before?

YesNo

a. If yes, how many summers has child participated in Freedom Schools (not including this summer)?

5. Has your child(ren) had any early childhood education prior to Freedom Schools?

yesno



   



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