Kids Kash Course Registration Form

We teach K-12 students to master money skills early so they can lead struggle-free lives as adults.

Choose your Kash Kids Class

Student's Name

Student's Address

City

State

Zip Code

Student number

AGE

Grade

School & Principal

Parent/Guardian's Full Name

Parent/Guardian's Address

City

State

Zip Code

E Mail Address

example@example.com

Home Phone

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

Emergency Contact Phone Number

Format: (000) 000-0000.

Emergency Contact Name and Relationship

Child's Gender

Child's Race

Child's Ethnicity

Do you live in a single parent home?

Does the student have either a 504 or IEP?

Would you like to be referred for free mental health services (local to Jacksonville)?

Check the box if you as a parent/guardian would like to attend any of the following financial literacy sessions

Note: All above questions are for data and funding purposes only

Parent/Guardian Signature