Team Up Team UP Team Up Site * Select Alden RoadPalm Avenue Child Details Name * Name First First Last Last Age * DOB * Sex * Male Female Shirt Sizes * Select Youth - XSYouth - SYouth - MYouth - LYouth - XLAdult- SAdult- MAdult- LAdult- XLAdult - XXXL Address * City * Zip * DCPS Student ID # (DCPS Students Only) * School * Current Grade * Select K12345678 Last 4# SS * Does your child have an IEP/504 evaluation Yes No Behavioral/Developmental Concern Eligibility * Select Proof of Free Lunch or Reduced Lunch Verification household does not exceed 100% of the state median income (SMI) for Duval County based on family size (pay stub)Under Protective Services or in Foster CareProof of an IEPRecipient of the Family Empowerment Scholarship with Unique Abilities If Other Ethnic Group * Select White/CaucasianBlack/African AmericanNative AmericanHispanicAsian/PacificMulti-RacialOther Medical Information Physician Name * Phone * Does your child have a medical condition (physical/mental) or needs? * Yes No If “Yes” please explain Does your child take prescription medication or allergic to non-prescription drugs or food? * Yes No If “Yes” please explain Add Another Child Remove Parent/Guardian Email Address * Household Income: * Select = or < $20,665|= or < $20,665= or < $27,991|= or < $27,991= or < $35,317|= or < $35,317= or < $42,643|= or < $42,643= or < $49,969|= or < $49,969= or < $57,295|= or < $57,295= or < $64,621|= or < $64,621= or < $71,947|= or < $71,947Unemployed * Family units exceeding 8 add $7,326 each person Number * If you are human, leave this field blank. Next
