Ivy City Clubhouse Registration Form

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* 1. Child’s Name & Nickname

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* 2. Child's Age

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* 3. Child's Date Of Birth

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* 4. Child's gender

Male

Female

Nonbinary

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* 5. Home Address (Ivy City residents only)

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* 6. Name of Child's School

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* 7. Grade level

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* 8. Child's interests or hobbies

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* 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)

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* 10. Does your child currently need a tablet/device for remote learning?

YES

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* 11. Parent or Guardian’s Information

Name

Phone number

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* 12. Would you like to volunteer at the Clubhouse?

YES

Ivy City Clubhouse Registration Form

Question Title

* 1. Child’s Name & Nickname

Question Title

* 2. Child's Age

Question Title

* 3. Child's Date Of Birth

Question Title

* 4. Child's gender

Question Title

* 5. Home Address (Ivy City residents only)

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* 6. Name of Child's School

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* 7. Grade level

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* 8. Child's interests or hobbies

Question Title

* 9. What would you like to see offered at the Clubhouse? Check all that apply

Question Title

* 10. Does your child currently need a tablet/device for remote learning?

Question Title

* 11. Parent or Guardian’s Information

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* 12. Would you like to volunteer at the Clubhouse?

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* 13. How would you like to help? (write in below)