Application for Littles

In order to be considered for our “Littles” program, a child must meet the following requirements:

"*" indicates required fields

Parent/Guardian*

First Last

Email*

Phone*

Child's Name*

First Last

Child's Date of Birth*

Child's Race*

If "Other", please specify*

Child's Gender*

If "Other", please specify*

Address*

Street Address Address Line 2 City State ZIP Code

County*

(We serve Lucas, Wood and parts of Ottawa County)

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