Board of Kid Directors Program —A Kid Led Think Tank

1

Name of parent/gaurdian:

First Name

Last Name

2

Name of your Kid Director:

First Name

Last Name

3

E-mail Address:

example@example.com

4

Phone Number:

5

Date of Birth of your Kid Director:

Date

6

Race and EthnicityWe are going to create our Board to be inclusive and diverse—and therefore very, very wise. Which race or ethnicity best describes your Kid Director?

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

Multiple ethnicity

Other

7

Does your Kid Director have any special needs?If yes could you please offer a brief description of the best ways for Big Brain Box to partner with your Kid Director around this need.

8

What kind of Board of Kid Director program are you interested in?Check all that apply.

Paid—I would like to pay

Free—I would like a sponsoring company to pay

9

Paid ProgramIf you are interested in a program that is NOT sponsored by a toy company (and therefore requires you to pay) how much would you be willing to pay? 9 Week Leadership Program, 1 zoom session (aka board meeting) per week for 1.5 hours.

10

Are you willing to sign a release?Some of the program's content (video/artwork/photos etc.) will appear on public platforms. Would you give permission for your child's image, video, and/or their artwork etc to be on public platforms?

Yes

Some but not all platforms

No

Need to talk about it

Yes, with certain checks in place

11

Time ZoneThe Board of Kid Directors Program is virtual. What time zone will your Kid Director be joining us from?