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Fresh Air Summer Interest Form
Thank you for your interest in Fresh Air fund 2021 summer programs. Please complete the form below.
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Summer 2021 Program Interest Form
If you would like to view this form in a different language please select from those available in the drop down. All re
sponses must be in English.
Parent/Caregiver Information
Parent/Caregiver
First Name
Parent/Caregiver
Last Name
Parent/Caregiver
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Parent/Caregiver
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Other:
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New York
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Preferred Household Language:
Please select...
English
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Other Language:
At least one of my children has already participated in a Fresh Air Fund program.
Yes
No
I am interested in:
Overnight Experience
In-person Experience in NYC
Virtual Experience
Family Wellness Day Trip
Number of children
between the ages of 5 and 17 who
participate or would like to participate in Fresh Air programs:
Please select...
1
2
3
4
5
6
7
8
9
10
To participate in Summer 2021 programs, children must be at least 5 years old on July 5, 2021. Children who will be 18 years old on July 5 will be eligible to apply for one of our summer employment opportunities. Please visit
https://freshair.org/join-our-team/
to learn more about open positions.
1st Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
2nd Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
3rd Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
4th Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
5th Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
6th Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
7th Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
8th Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
9th Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
10th Child
First Name
Last Name
Date of Birth
Current Age
Please select...
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Gender
Please select...
Male
Female
Other
Other Gender
Relationship to Parent/Caregiver
