Enrollment | Kids Club

Child #1 First name

Last name

Birthday

Grade in 2024-2025 (This school year).

Age

List any allergies, diagnosis, or any medical issues/needs.

Are there any developmental delays/concerns?

What would you like us to know about your child?

School Attends

What is your start date?

Child #2 First & Last Name (If needed)

Birthdate Month, date, year

Age

School Attends

Are there any developmental delays/concerns?

List any allergies, diagnosis, or any medical issues/needs.

What would you like us to know about your child?

Parent/Guardian #1 First & Last Name

Country/Region

Address

City

Zip / Postal code

Phone

Parent/Guardian #2 First & Last Name

Country/Region

Address

City

Zip / Postal code

Phone

Parents are:

Emergency Contact #1 First & Last Name

Emergency Contact #1 Relationship

Emergency Contact #2 Phone Numbers

Emergency Contact #2 First & Last Name

Emergency Contact #2 Relationship

Emergency Contact #2 Phone Numbers

I give permission for my child to be transported in a vehicle or bus by Kids Club.

I give permission for my child to attend all off-campus field trips. These field trips are communicated to parents prior, they could include but not limited to: Parks, Museums, Gyms. Movies. Schools. Swimming Pools. Sledding. Ice Skating. Roller Skat

Photos of my children may be used on our Facebook page which is open to the public.

I understand there is an Inconvenience Fee that will be assessed on days that my child does not need to be picked up after school and I fail to communicate to daycare. I understand it needs to be communicated via Procare/Brightwheel.

I hereby give permission for my children to be given emergency treatment by an employee of Kids Club and by a treating physician/emergency room and to be transported by vehicle or ambulance to an emergency center for treatment.