New Participant Interest Form
We are so excited that you found us, and that you are interested in allowing us to provide an extra positive support for your child! Please share some basic information about your child so we can begin to know where your child might best fit in our program, and Director Tara Steiner will follow up soon! Once I have your child's basic background and your contact information from this form, you will have a spot reserved on the waiting list and will be contacted when we have new class spots to offer. At this point in time, the program may be full for all scheduled summer class options, so you are probably looking at the coming school year with evenings/Saturday class options that may be the next to open up for your child, so you can respond to the scheduling preference questions accordingly. However, even if your school-year schedule is too full and you are only interested in enrolling for classes in the summer, getting on the waiting list NOW ensures your child a top spot to be first offered a class next summer so you'll know they will get in--if that is your preference just indicate that on the form as well! Thank you!
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Child's NAME and AGE
Parent/Guardian Name(s) and Relationship to Child *
Email *
Address *
Phone number
Briefly explain how your child fits with the mission and target group for our program, and why you believe your child could benefit from the extra support of a program like Stirrup Courage. What would you say are some of your child's biggest challenges/obstacles to overcome currently?
How did you find out about our program?  If you were referred by another community organization/school/counseling agency/etc., please name them:
When we begin to schedule classes, it is helpful to have an idea of what will work best for families. Please check all possible days/times in June/July that would generally work best for your family to help us in offering class options that will fit the most schedules when putting groups of children together.
10:00-11:00am
1:00-2:00pm
2:00-3:00pm
3:00-4:00pm
4:00-5:00pm
6:00-7:00pm
7:00-8:00pm
Monday
Tuesday
Wednesday
Thursday
Friday
The cost of a 4-week intro/beginner session is $100. We ask all families to pay as much as they are able so we can sustain the program while serving as many children as possible, and offer scholarships to help cover costs that would be a barrier to participation for some families. Please respond if you would be likely to request a scholarship, and in what amount, to help us anticipate our sponsorship funding needs.
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Any other comments or information we should know? (Specific weeks/days of the summer child will be unavailable because of trips, camps, etc. will be helpful!)
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