Clarence Destination ImagiNation

 
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2008-2009 Application
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INSTRUCTIONS:
Please fill out the application below with YOUR NAME and information. There is also an area below to fill out information for up to three students who are applying for DI this year. For each of these students, provide complete information. If you have more than three students, please provide their information in the Other Information box at the bottom of this form. You must click on the APPLY button at the bottom of the form in order for your application to be submitted. If you leave this site before doing this, your changes will be lost.

NOTE that this is an application and does not guarantee your child a spot on a team. Every year there are more applicants than there are Team Managers. Help us place all children by volunteering today! Information is available on our main website or email us here.
* This Field is required Information for: Your First Name : Make sure to enter your information and not your child's.  You will have a place later in the form to enter your child's information.
* This Field is required Information for: Your Last Name : Make sure to enter your information and not your child's.  You will have a place later in the form to enter your child's information.
* This Field is required Information for: Email : Please enter a valid email address as the application process cannot be completed without it.  Make sure to check your email once submitted so your application can be processed without delay.  Your email and other information is being collected as part of the application process and to enable ongoing communication with you concerning Clarence Destination ImagiNation.  We will not resell or distribute your email or other information outside of the Clarence DI organization.
* This Field is required Information for: Username : This is more for future use as we are building a new website which will require a username and password to access.  Please enter a valid username with no spaces and at least 3 characters that contain a-z, A-Z, and 0-9.
* This Field is required Information for: Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
* This Field is required Information for: Verify Password : Please enter a valid password. No spaces, at least 6 characters and contain lower and upper-case letters, numbers and special signs
* This Field is required Information for: Address : Please enter your street address (we request no PO boxes).
Information for: Address (line 2) : A second address line is provided should you need it.
* This Field is required Information for: City : Please enter you city.
* This Field is required Information for: State : Please enter your state (default is NY).
* This Field is required Information for: Zip Code : Please enter you zip code.
* This Field is required Information for: Primary Phone(###-###-####) : Please enter the main contact phone number.
Information for: Secondary Phone (###-###-####) : Please let us know if you have another number we can reach you at.
Information for: Spouse Full Name : Please enter the name of your spouse.
* This Field is required Information for: Emergency Contact Info : Please give us the name, address, phone number(s), and relation of an emergency contact.
* This Field is required Information for: Meeting Conflicts (when your kids cannot meet) : Meetings are organized by Team Managers at their convenience.  We need to know if there are any days or times when you or your child(ren) absolutely cannot meet.
* This Field is required Information for: DI Role (check all that apply) : What is your role and affiliation with Clarence Destination ImagiNation?  Check all that apply.
* This Field is required Information for: I am willing to (check all that apply) : Destination ImagiNation is a volunteer run organization.  As such, we rely on the generous support of parents to help in any way they can.  Please let us know how you and other family members can help DI and your child get the most out of this experience.  Check all that apply.
Information for: Other Information : Is there anything else we should know about your child(ren) such as allergies, conditions, and other pertinent information?

Please work together with you child to fill out ALL information below.
* This Field is required Information for: Full Name : Please enter the full name of the student in your family requesting to be in Destination ImagiNation.
* This Field is required
* This Field is required Information for: School : Select the school the student is attending this year from the drop down list.
* This Field is required Information for: Grade : Please enter the grade number the student is attending this year.
* This Field is required Information for: Teacher : Please enter the Teacher's last name.  For older children, please enter their homeroom teacher.
* This Field is required Information for: Abilities     (check all     that apply) : What abilities and strengths does this student have?  Check all that apply.
* This Field is required Information for: Why DI? : Please tell us in the child's own words why he/she wants to be involved in Destination ImagiNation.
Information for: Challenge     Preference(s)     (check all     that apply) : Please select one or more of the challenges in which this student has interest in.  More information on each challenge can be found on our website.
Information for: Team Request : Is there a particular team or team manager that this student would like to request?

Please work together with you child to fill out ALL information below.

Information for: Full Name : If you have a second student in your family requesting to be in Destination ImagiNation, please enter their full name here.
Information for: School : Select the school the student is attending this year from the drop down list.
Information for: Grade : Please enter the grade number the student is attending this year.
Information for: Teacher : Please enter the Teacher's last name.  For older children, please enter their homeroom teacher.
Information for: Abilities     (check all     that apply) : What abilities and strengths does this student have?  Check all that apply.
Information for: Why DI? : Please tell us in the child's own words why he/she wants to be involved in Destination ImagiNation.
Information for: Challenge     Preference(s)     (check all     that apply) : Please select one or more of the challenges in which this student has interest in.  More information on each challenge can be found on our website.
Information for: Team Request : Is there a particular team or team manager that this student would like to request?

Please work together with you child to fill out ALL information below.

Information for: Full Name : If you have a third student in your family requesting to be in Destination ImagiNation, please enter their full name here.
Information for: School : Select the school the student is attending this year from the drop down list.
Information for: Grade : Please enter the grade number the student is attending this year.
Information for: Teacher : Please enter the Teacher's last name.  For older children, please enter their homeroom teacher.
Information for: Abilities     (check all     that apply) : What abilities and strengths does this student have?  Check all that apply.
Information for: Why DI? : Please tell us in the child's own words why he/she wants to be involved in Destination ImagiNation.
Information for: Challenge     Preference(s)     (check all     that apply) : Please select one or more of the challenges in which this student has interest in.  More information on each challenge can be found on our website.
Information for: Team Request : Is there a particular team or team manager that this student would like to request?
 

To complete the application process, make sure to read the Terms and Conditions and check off the box above if you agree. Then click on APPLY below. Any incomplete information will be noted above and you must correct these before the application is accepted. If all information is filled out correctly, you will receive an email confirming our receipt of your application.

NOTE, you must confirm your email for us to process your application further. Check your email and make sure your spam filter knows to accept email from clarencedi.com.

Thank you for taking the time to fill out the online application. Again, help us place all children this year by joining this ALL VOLUNTEER team of fun, dynamic, and exciting people. Check out our website or contact us by clicking here.
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Administrative Use Only