2022 WILD TENDERS AFTERSCHOOL WEDNESDAY INTEREST FORM

WILD TENDERS AFTERSCHOOL WEDNESDAY INTEREST FORM

2022/23
I. CONTACT INFORMATION
Your Name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
II. WHO ARE YOU INTERESTED IN APPLYING FOR?

Let us know who about each child you'd like to participate.
1. Child's Name*

First NameLast Name
CHILD FULL NAME
1. Child's Date of Birth*

MonthDayYear
AGE
1. What school is {1Childs} currently enrolled in?*
2. Child's Name

First NameLast Name
CHILD FULL NAME
2. Child's Date of Birth

MonthDayYear
AGE
2. What school is {2Childs} currently enrolled in?
3. Child's Name

First NameLast Name
CHILD FULL NAME
3. Child's Date of Birth

MonthDayYear
AGE
3. What school is {3Childs} currently enrolled in?
III. LOGISTICS
Would you be able to drive your child to the Wild Tenders Afterschool Program on Wednesdays or do you need transportation?*

I can driveI can drive as long as the program site isn't too farI need transportation
Are you able to pay the sliding scale amount for this program? (Between $2200 - $2600 per child)*

YesNo, we would need financial assistance
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 would you be able to pay for this program?*
Between 0 - 2200
Thank you for taking the time to fill out this interest form! We will be in touch soon. In the meantime, please reach out to youthprograms@weavingearth.org if you have any questions.
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WILD TENDERS AFTERSCHOOL WEDNESDAY INTEREST FORM

I. CONTACT INFORMATION

II. WHO ARE YOU INTERESTED IN APPLYING FOR?

III. LOGISTICS