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Welcome to L.A.U.N.C.H for Life!
Please answer the following questions to help us get to know you and your child. Thank you!
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Applicant Legal Name
*
Your answer
Applicant Age
*
Your answer
What is your child's preferred name?
Your answer
What pronouns does your child prefer? (For example: he/him/his or they/them/theirs)
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian phone number (best number to reach you):
*
Your answer
Parent/Guardian email:
*
Your answer
Address where the child resides:
Your answer
What is your preferred method of communication?
*
Text
Phone
Email
County & School of Residence
*
Your answer
Is your child prepared to commit to participating in this 12-month program to include attendance at one event per month or equal to 4 hours a month (minimum)?
Yes
No
Clear selection
Can your child attend all three days of the L.A.U.N.C.H. kick-off camp on August 7, 8, and 9th? (from 9-4:00)
Yes
No
Maybe
Clear selection
If your child can't attend all 3 days of camp, please indicate which days you can attend.
Your answer
Applicant's shirt size
*
XS
S
M
L
XL
Youth sizes
Adult sizes
Required
Applicant's medical needs (if applicable):
*
Your answer
Does your child have any allergies to food, the environment, or medicines? (Please list)
*
Your answer
Do you need assistance with transportation for your child, to and from events?
Yes
No
Maybe
Clear selection
Are you and your child safe at home?
*
Yes
No
What does your child do well? When are they at their best?
*
Your answer
What interests and excites your child?
Your answer
What kinds of situations are difficult for your child?
Your answer
Who do they most look up to or admire in your family and/or community?
Your answer
List any other activities outside of school your child is involved in:
Your answer
Does your child need or receive extra help at school?
Your answer
What is one thing you hope your child will gain from this program?
*
Your answer
Would you like to participate in our support group for moms/guardians?
*
Yes
No
Not sure yet
If you would like to attend activities for moms/guardians through our program, do you need childcare provided for younger children? (Please list names and ages of siblings that would need care)
Your answer
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