A. 2022 WILD TENDERS AFTERSCHOOL THURSDAY APPLICATION

WILD TENDERS AFTERSCHOOL THURSDAYS APPLICATION PART A

2022/23
Thanks for taking the time to fill out these forms! Part A asks about contact and program information. Part B (which you can access after completing Part A) asks some short answer questions so we can get to know your child and your family a bit better. If you have any questions, please contact youthprograms@weavingearth.org.

NOTE: If you already applied for a Wild Tenders daylong program this year, you DO NOT need to fill out this application. Let us know you'd like to apply for Afterschool Thursdays by sending us an email at youthprograms@weavingearth.org and we will take care of the rest.
I. CONTACT INFORMATION
Your Name *

First Last
PARENT FULL NAME
Pronouns
E-mail *
Phone Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Partner/Co-Parent's Name

First Name Last Name
PARTNER/CO-PARENT FULL NAME
Pronouns
Partner/Co-Parent's Email
example@example.com
Partner/Co-Parent's Phone Number
Is your Partner/Co-Parent's address the same as above?

Yes No
Partner / Co-Parent's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How did you find out about this program? *
Please explain: *
II. WHO ARE YOU APPLYING FOR?

REMINDER: IF you are applying for multiple children, we need a separate application for each child.
Child's Name *

First Name Last Name
CHILD FULL NAME
Child's Date of Birth *

Month Day Year
AGE
Child's Gender Identity
Child's Pronouns
What school is your child currently enrolled in? *
Are any other siblings planning on applying or attending the after school program? *

Yes No
#1 Sibling's Name

First Name Last Name
#2 Sibling's Name

First Name Last Name
#3 Sibling's Name

First Name Last Name
III. PROGRAM INFORMATION

REMINDER THAT WILD TENDERS AFTERSCHOOL THURSDAY PROGRAM RUNS FROM 1-5 PM
Please select the age range that your child will be in as of September 2022. *

4 - 6 7 - 9 10 - 12
Are you able to pay the sliding scale amount for this program? (Between $2200 - $2600) *

Yes No
What amount on the sliding are you able to pay? *
Between 2200* - 2600. *The lower end of the sliding scale is less than the annual cost per child needed to meet our organizational expenses, which include staff pay and benefits, program site rent, materials, and insurance.
How much could you pay for this program? *
Between 0 - 2200
Our program site is a 15 minute drive northwest of downtown Sebastopol and a 20 minute drive from downtown Santa Rosa. Would you be able to drive your child to the Wild Tenders Afterschool Program on Thursdays or do you need transportation? *

I can drive I can drive and offer a carpool I need transportation
IV. SCHOLARSHIP INFORMATION

If you are applying for multiple children, you only need to fill this out once
What is your household size? (please include all individuals you are primarily financially responsible for, even if they do not live at your physical residence)
Please describe your financial situation in a sentence or two
If you feel comfortable doing so, please describe any systemic barriers you face and/or aspects of your social positioning that you feel are relevant to your financial situation or your request for a scholarship (e.g. race, socioeconomic status, single parent/guardian, disability, etc.)
What is your household's annual gross (pre-tax) income? (please round to the nearest thousand dollars)
e.g. $61,547 would be $62,000
Do you foresee this income changing in the next six months?

Yes No Maybe
Please explain:
Thank you for taking the time to fill this application out! Once you submit, you will receive an email with information about next steps. If you haven't received that email within 24 hours, double check your spam folder and if it isn't there, please reach out to youthprograms@weavingearth.org.
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WILD TENDERS AFTERSCHOOL THURSDAYS APPLICATION PART A

I. CONTACT INFORMATION

II. WHO ARE YOU APPLYING FOR?

III. PROGRAM INFORMATION

IV. SCHOLARSHIP INFORMATION