DREAM Youth Enrollment Form (for paper upload ONLY)

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Receive free/reduced lunch at school?
Does your child participate in another mentoring program or other after-school groups?
May DREAM reach out to a teacher of your child or other school personnel to support your child's schoolwork, mental and physical health, and/or wellbeing?
What DREAM program(s) is the family interested in?
Parent/Guardian Information (1)
Parent/Guardian Information (2)
Emergency Contact Information (other than parent/guardian)
Person 1
Person 2
Person 3
Emergency Contacts that can pick up, drop off, and/or accept youth:
 YesNo
Emergency Contact #1
Emergency Contact #2
Emergency Contact #3
Additional People who can pick up, drop off, and/or accept youth from programming:
 Full NameRelationship to YouthPhone Number
#1:
#2:
#3: