If you have any questions, please email us at email@example.com
Youth First Name:
Youth Last Name:
Youth Birthdate mm/dd/yy:
Youth Phone Number:
Youth Grade Level in September 2022:
Current School Name:
Youth address where they will be living during the school year:Street # and Street Name:
Are there any accessibility, medical or disability needs or preferences for the youth? For example, if the youth uses closed captions or translated literature.
Please list all food allergies or dietary restrictions here:
Does the youth have a laptop or Chromebook? If you select “NO,” we may be able to provide one:
Your participation in Detroit Food Academy comes with a free subscription to Coursera, a global online learning platform where you and/or your family can learn new skills, languages and earn college credits. Would you like to sign up for a free Coursera account?
What is the primary language spoken at home?
By typing your name in the following box, Parent (or participant if over the age of 18), you are signifying you have fully read and understand the Participant Release & Waiver of Liability, Consent and Release for Use of Story, Likeness, and Voice, Consent for Communications, and the Consent for Deliveries.
This acts as your digital signature and is legally binding. Please type the parent or guardian’s full name here:
Parent Phone: Parent Email:
Is this the first time your youth is applying to Detroit Food Academy?
Check this box if you would you like to sign up for our quarterly newsletter:
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