KAP Summer Program Registration Form

KAP-Ketchikan Afterschool Program

Summer Program Registration form
Totally FREE

About the Ketchikan Afterschool Program (KAP)

Island-wide indoor-outdoor program featuring various workshops with a strong focus on the arts, sports, and outdoor education. The Ketchikan Summer Program (KAP) is open to all Middle School Youth in the 2021-2022 school year.

The KAP Summer Program: Participation in the Ketchikan Afterschool Program is free. These trips will provide all food, essential equipment (tents, sleeping bags, water filters, etc.) and we can provide some personal equipmet (rain gear, non-cotton thermal wear) all free of charge. The requirnments for these trips are for the safety of participants and staff so there are no exceptions. Our backpacking trips unsupported, we pack everything in and out so there will be limitations on what participants can pack. All backpacking and campground trips include a manditory meeting for both the participant AND the parent/legal gardian prior to the trip. Details are availble on our website for these meetings. We will do what we can to accomadate any needs so please get in touch to see what we can do to get yout youth outside this summer!

Participant Information
First Name*
Legal First Name
Last Name*
Legal Last Name
Gender*

MaleFemale
Birth Date*

MonthDayYear
Home Phone*

Area CodePhone Number
Please choose the Trip or Workshop you are signing up for.*
Has your child participated in a tirp like this before? If so what kind of trip; duration, distance, support, etc.*
Please tell us about your child. Describe his or her interests, hobbies, extracurricular activities, and anything else that will help us get to know your child better.*
Is there a particular workshop that you are signing your youth up for? If so, please enter the name of that workshop here.

Youth School Information
Grade*
What gade will your youth be enrolled in for the 21-22 School Year?
School*
What is the name of the school that your youth will attend in the 21-22 school year?
Parent/Guardian Information 1
Full Name*

First NameLast Name
Home*

Area CodePhone Number
Cell*

Area CodePhone Number
Work

Area CodePhone Number
E-mail*

Emergency Contact

Other than Parent/Guardian
Full Name*

First NameLast Name
Home*

Area CodePhone Number
Work

Area CodePhone Number
Cell*

Area CodePhone Number

Medical

All health/medical information is protected under HIPAA regulations and is kept in the strictest of confidence among only those staff who will travel with your child. As these activities involve remote locations it is critical our staff are aware of ANY medical conditions, medications or injuries in order to KEEP ALL PARTICIPANTS SAFE.
Does the participant have any injuries or medical conditions which puts themself or other participants at greater risk?*

Yesno
Please explain
Please list any allergies the Participant has. This includes food allergies.*
What are the possible reactions associated with these allergies?*
Remedies/ treatment *
Does the Participant carry an EPIPEN?

yesno
Current, past or chronic injuries requiring medical attention or which have resulted in limited movement or ability*
List any medications the participant will bring on the trip and dosage*

Transportation

These trips involve vehicle transportation, and for the backpacking trips there will be additional boat transportation. Please read the Transportation and Liability Waiver below and if you agree please indicate in the appropriate field.
I permit

Lack of Access to a Vehicle at HomeParent/Guardian Works in the Evening
Signature

Clear

Please press Submit

If all you information is correct your registration is ready to submit. Press the button below to complete your registration.
Please contact me directly if you have further questions about our Summer Programs or any KAP workshops.

THANK YOU!!!

Contact Information:

Director: Andrew Eisenberg

andrewe@rycalaska.com

907-202-5404

www.ricorps.org

Ketchikan Afterschool Program
2417 Tongass Ave
STE# 209(C)
Ketchikan, Alaska 99901
Type a question
Thank You for Your Interest in the Ketchikan Afterschool Program!
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