School/Club Information Form

School/Club Information Form

To be completed by Team Leader or Team Admin by July
YesNo

Team Leader Info
Returning Club & Team Leader*
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Facility Information
School District Name*
Shool/Club Name*
Club Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Classroom # *
Open to what grade levels? *
e.g. K-6
For what age range?*
e.g. 5-12
SundayMondayTuesdayWednesdayThursdayFridaySaturday
Club Start Time (On Flyer & Website)*
xx:xx AM/PM
Club End Time (On Flyer & Website)*
xx:xx AM/PM
Facility Permit Request Start Time*
Facility Permit Request End Time*
First Date of Club (MM/DD/YYYY)*
Last Date of Club (MM/DD/YYYY)*
Any change to your previous year's club Info? (Date/Time/Classroom#/Phone # on Flyer) *
List ALL Dates of Use (As Per School District Requirement)*
Specify club non-meeting dates (list the dates for your club's actual skipped dates of thanksgiving, winter/spring break, etc.)*
Contact Name on Flyer*
Contact Number on Flyer*
Please enter a valid phone number.Format: (000) 000-0000.
List all confirmed volunteer names*
List all potential volunteer names*
Got questions/comments? Please also provide preferred date(s) for Edeliza to visit, observe and encourage the team.*
Should be Empty:

Team Leader Info