Farm to Table Interest Form.Please complete the form to receive more information. Name of Guardian * First Name Last Name Name(s), Age(s), and Grade of Student(s) * If multiple children, please include all children's names, ages, and grades. Example: Pablo - 10 years old, 4th grade and Susan - 8 years old, 2nd grade What city do you live in? * Phone * (###) ### #### Email * Farm to Table Goals * We'd love to know what goals, dreams, or outcomes you're hoping for by enrolling your child in this program! What information are you looking for, or what questions can we answer for you? * Payment Options * OPO- Out of Pocket Charter Funds If you are paying with charter school funds, what is the name of your charter school? * If you are not part of a charter school, please simply write "none." Day of the Week Desired * Monday Tuesday Wednesday Thursday Friday Age * 3 4 5 6 7 8 9 10 11 12 13 How did you hear about us? / Who referred you? * Medical needs, special needs, or allergies we need to know about? * Also, if your child has a learning or developmental difference which requires additional support in program settings, we would want to discuss that before you enroll. Thank you! Preferred method of communication? * Text Email Any additional comments or questions? Thank you!