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Home
About Us
Our Programs
Partners
Papa Rap
Forms
Media
OneCommunity Scholarship
Events
ArkanSalsa Fest 2022
Contact Us
Donate
English
(
English
)
Feed Your Brain, Alimenta tu Cerebro Registration Forms_English
Feed Your Brain, Alimenta tu Cerebro Registration Forms_English
School Lunch Location (Which school will you be attending for the FYB program?):
*
Year
*
Please enter a number from
2020
to
2030
.
Mr./Mrs. Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Alt. Phone Number
Email
Ethnicity
*
Father
Mother
Children
Employer: Father
Employer: Mother
Number of People in Family:
*
Please enter a number from
1
to
50
.
Annual Income:
*
0-$10,000
$10,000-$20,000
$20,000-$30,000
$30,000+
Your Child’s Name (Click plus sign (+) to add more children)
*
First Name
Last Name
Age
School
New Grade
DOB
Consent
*
I give OneCommunity permission to obtain results from my child’s test scores, grades, and additional data from my child’s school.
Photo/Video Image Release
*
I hereby consent to and authorize the use and reproduction by OneCommunity, or anyone authorized by OneCommunity of any and all photographs/video images that have been taken of me this day for any purpose, without compensation to me. All negatives, positives, digital files, together with the prints, are the property of OneCommunity. OneCommunity reserves the right to use these photographs in any of its print or electronic publication for any length of time. I hereby acknowledge that I am 18 years of age or older and have read and understood the terms of this release.
Date
*
Date Format: MM slash DD slash YYYY
Signature:
*
Please type your name for Signature
Signature