Forms

Child Enrollment Form

CHILD

Name *

First

Last

Date of Birth *//

Gender

Race / Ethnicity

Date of Placement: //

CPS INVOLVEMENT

Is the child currently involved with CPS? *

Carrying Case Worker:

Case Worker Phone

Case Worker Email *

County *

Current zip code *

Guardian's Name *

Phone

Email *

CHILD’S HEALTH INFORMATION

Does the child currently suffer from health problems?

Yes
No
Unknown
Declined to State

In case of Emergency please list names and phone numbers of two other contacts:

Does the child have any therapeutic services in place?

Yes
No
Unknown
Declined to State

EDUCATION

Is the child currently attending school?

Yes
No
Not School Age

Does the child have any of the following?

School Name:

Grade Level:

School District:

EXTRACURRICULAR/ ENRICHMENT ACTIVITIES

Please list other activities here:

What additional resources would be helpful for your family to ensure your child could participate in the activity of their choice?

Caregiver's Printed Name

Caregiver's Signature

Date

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Teams & Dreams Foundation

Teams and Dreams is a US-based 501(c)3 nonprofit charity organization that create opportunities and supportive services for foster children to reach their dreams by providing access to extracurricular and enrichment activities.

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