LOOK! 2021 Participant Application Participant Information Participant First Name Participant Last Name Participant Age Date of Birth Diagnoses (List any that apply): GenderPlease select... Male Female Other Prefer not to answer Child's school informationChild is not in schoolChildcareChild is in school School Name Current GradePlease select... Childcare/Daycare Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th beyond high school Why is your family interested in LOOK!? Has the participant been part of Look before? Parent Information First Name Last Name Email Phone TypePlease select... Work Mobile Home Mobile Phone Home Phone Work Phone Mailing Street Mailing City Mailing State Mailing Zip Does the participant or family have a language preference or communication needs?Please select... English Spanish Other Other Language Preference CountyPlease select... Abbeville Aiken Allendale Anderson Bamberg Barnwell Beaufort Berkeley Calhoun Charleston Cherokee Chester Chesterfield Clarendon Colleton Darlington Dillon Dorchester Edgefield Fairfield Florence Georgetown Greenville Greenwood Hampton Horry Jasper Kershaw Lancaster Laurens Lee Lexington Marion Marlboro McCormick Newberry Oconee Orangeburg Pickens Richland Saluda Spartanburg Sumter Union Williamsburg York Out of State reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Comments are closed.