L4L Farm Lab Application
Student Information
Student Name
*
First Name
Last Name
Entering Grade Level
*
Age
*
Name of School (ex. Canal, Johnstown, Central, etc...)
*
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
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Questionnaire
Are you able to provide transportation?
*
Please Select
Yes
No
Does your child have any allergies?
*
Please Select
Yes
No
If yes, please provide more information.
Is your child able to work independently with supervision for a minimum of 30 minutes at a time?
*
Please Select
Yes
No
What kind of accommodations will your child require while under our supervision? (Ex. access to fidgets, frequent breaks, headphones/noise sensitivity, etc...)
*
What activities currently interest your child? (select all that apply)
*
Working in the hoop house/gardening (greenhouse)
Animal care (alpacas, cats rabbit)
Hands-on, craft activities
Bee education/activities
Independent living practice (cooking, laundry, etc.)
Indoor activities working on job readiness skills
Tell us more about your child! Include any information that you feel is important for our team to consider.
*
Submit
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