Aurora Kid's Club Before and After School Care

Student Registration Form

Fill out the form carefully for registration
Thank you for registering for Aurora Kid's Club Before and After School Care Program. Please note your child's spot in the program is not secured until a $50 application fee is paid and confirmation of receipt and acceptance is given. Once your child is accepted into the program, an additional $50 materials fee will be charged. Once this application is received, you will be contacted for payment.
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Parent or Guardian Name

First Name Last Name
Parent/Guardian E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Student's school where they are currently enrolled:
Name of Teacher/Room #
Grade in School (2021-2022 School Year)
What program are you interested in:

Before School (6:00 am to 8:30 am) After School (3:30 pm to 6:00 pm) Both Before and After School Programs Other
When do you expect start to begin for your child?

Month Day Year
Date
Additional Comments
Should be Empty:

Student Registration Form