CREATE A LOOP SATURDAY CLUB Registration Applicants Name * First Name Last Name Applicant's Birthdate * MM DD YYYY School * Grade * Select One 3rd 4th 5th 6th 7th 8th Gender Select One Male Female Other Prefer Not to Select Desired Session * Select a Session Winter 2024 February - May Fall 2024 October - December Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/Guardian Name * First Name Last Name Parent/Guardian Number * (###) ### #### Email Address * Explain what you hope your child will gain from this experience: Please list any allergies or medical conditions. * Please note any social, emotional, or academic information we should know. * Are you applying for a scholarship? * Yes No Partial If you are applying for a scholarship, please include your household income. THANK YOU!You will receive an email from Create a Loop with further information including payment options, potential scholarship opportunities, times, location, and more.
