KidREACH and REACH.U Enrollment 2023.24 ROADTRIP with US!
Please fill out entire form for each child enrolling in the program.
Sign in to Google to save your progress. Learn more
Email *
Child's Name: Last *
Child's Name: First* *
Parent/Caregiver Email Address (NOT student email) *
School Attending: *
Grade Level: *
Student Birth Date *
MM
/
DD
/
YYYY
Parent/Guardian Name(s) *
Preferred Contact #1 (Name and Number) *
Preferred Contact #2 (Name and Number) *
Preferred Contact #3 (Name and Number) *
Primary Mailing Address *
Emergency Contact #1 : Name and Phone Number (Not listed above) *
Emergency Contact #2 : Name and Phone Number (Not listed above) *
List those individuals allowed to pick up your child from KidREACH and their phone numbers:
Can this child have a photographed published? *
We have easy access to reliable internet *
Grant Required Questions
KidREACH uses the following information for the sole purpose of grants and fundraising. All information will remain confidential and anonymous.
Student Ethnicity *
Gender *
Is the student eligible for free and reduced lunch at school? *
Does the student have an IEP or 504 plan? *
Please select the type of household the student resides in the majority of the time: *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Barbour County Schools. Report Abuse
Google Forms