MDV KIDS

MDV Kids Before/After Care/Transportation

2024-2025 REGISTRATION FORM
Please choose service. (AFTER FORM IS COMPLETED PLEASE GO BACK TO MDVKIDS.COM TO COMPLETE PAYMENT LINK. ONCE BOTH REGISTRATION FORM AND PAYMENT LINK IS COMPLETE THE STUDENT WILL BE ADDED TO BEFORE CARE LIST)

Before Care 7:00am-8:30amAfter Care 1:00-6:00pmTransportation
Child's Name
Date of Birth
School Name/Grade Level
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT/GUARDIAN INFORMATION
Full Name

First NameLast Name
Cell Phone #

Area CodePhone Number
Alternate Phone #

Area CodePhone Number
Full Name

First NameLast Name
Cell Phone #

Area CodePhone Number
Alternate Phone #

Area CodePhone Number
EMERGENCY CONTACT INFORMATION: Other than Parent/Guardian
Full Name

First NameLast Name
Phone #

Area CodePhone Number
Relation
Full Name

First NameLast Name
Phone #

Area CodePhone Number
Relation
Registration assumes full participation in the ENTIRE school year. You may cancel enrollment by contacting MDV KIDS. Your first week payment is required at the time of sign up. There is a $10 late fee if tuition is not received by Monday Mornings of each week and a $25 fee for checks with insufficient funds - unless otherwise arranged. I hereby grant permission for my child to attend and participate in MDV KIDS program listed herein & agree to the Terms and Conditions set forth herein. Payment is still due on Monday even if child is absent to secure the students spot in the program. I am 18 years of age or older and the parent or legal guardian of the above-named child.
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MDV Kids Before/After Care/Transportation