Kids Kash Course Registration Form

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
Cell Phone*
Emergency Contact Phone Number*
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?

YesNoCurrently, working on it
Would you like to be referred for free mental health services (local to Jacksonville)?

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

Passion for PayWhat Is My Side Hustle?Cars and Credit?Fun Financial BasicsInvestingInsurance Basics
By checking this box, I consent to my child to be placed on the Kash Kids social media pages.
Note: All above questions are for data and funding purposes only
Parent/Guardian Signature

Clear

PAYMENT OPTIONS

ANOTHER WAY TO PAY

To Pay per class - $25.00 or One-Time payment of $150

Use CashApp $UAOC501C3
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform