Parent or Caregiver 1 Full Name /// Madre/Padre nombre completo
*
First Name
Last Name
Preferred pronouns / Pronombres preferidos
Phone number / Número de teléfono
(###)
###
####
Email
Address (street, city, zip) / Dirección (calle, ciudad, código postal) *
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent or Caregiver 2 Full Name /// Madre/Padre nombre completo
First Name
Last Name
Preferred pronouns / Pronombres preferidos
Phone number / Número de teléfono
(###)
###
####
Email
Name(s) , Pronoun(s), Age(s) of children applying
*
How interested is your family in participating in Liberated Kids during the Fall 2024 Session? /// ¿Qué tan interesada está su familia en participar en Niñ@s Liberad@s durante el otoño de 2024?
Why is your family interested in being part of Liberated Kids?
How did you find out about Liberated Kids?
How many days per week are you interested in participating in Liberated Kids? /// ¿Cuántos días a la semana le interesa participar en Niñ@s Liberad@s?
What type of education has your child(ren) experienced? (mark all that apply) // ¿Qué tipo de educación ha experimentado su(s) hij@(s)? (marque todo lo que corresponda)
Checkbox
Your Family's Race / Ethnicity (mark all that apply)
What other information do you want us to know about your child/family? What other questions do you have?