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Ivy City Clubhouse Registration Form
1.
Child’s Name & Nickname
2.
Child's Age
3.
Child's Date Of Birth
4.
Child's gender
Male
Female
Nonbinary
5.
Home Address (Ivy City residents only)
6.
Name of Child's School
7.
Grade level
8.
Child's interests or hobbies
9.
What would you like to see offered at the Clubhouse? Check all that apply
Child’s hobbies and interests:
Tutoring / academic support
Arts and crafts
fitness / dance
sports
meals / snacks
computer lab
gardening
Other (please specify)
10.
Does your child currently need a tablet/device for remote learning?
YES
NO
11.
Parent or Guardian’s Information
Name
Email
Phone number
12.
Would you like to volunteer at the Clubhouse?
YES
NO
13.
How would you like to help? (write in below)
Current Progress,
0 of 13 answered