Kiddies Klubhouse Learning Center Online Application

Emergency Contact 1
Name*

First NameLast Name
Phone Number (Home)

Area CodePhone Number
Phone Number (Mobile)*

Area CodePhone Number
Phone Number (Work)

Area CodePhone Number
Relationship*
Physician and Medical Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number*

Area CodePhone Number
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.*

Notes
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.
Additional documents for registration

Please upload below or bring the following documentation to the school office.

• Original Certified Birth Certificate
• Parents ID
• Passport or 1 Photo size photo
• Current Proofs of Residence (ex. power, water, or gas bill)
• Immunization Book (Medical Passport, pg 15)

NB: A Registration Fee of $4,500 JMD is to be paid whether at the office or through the bank.
Please upload documents below:

Cancelof
Should be Empty:

School Registration