After-School Kids Club Registration

After-School Kids Club Registration

EQUITY STATEMENT: KATB's primary focus and concern are with the physical, mental, and emotional safety and well-being of all the children in our program, as well as that of our staff and the communities we serve. We ask that if parents or guardians have questions or concerns about programming, rules, policies and procedures, or anything else they reach out to our Director. This will ensure that staff is able to focus on the enrichment activities being provided to children.
Child Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
Grade Level *

First Grade Second Grade Third Grade Fourth Grade Fifth Grade
Parent or Guardian Name *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Does your child have any allergies that we should be aware of? *
Does your child have any medical conditions that we should be aware of? *
Does your child qualify for Free/Reduced Lunch? *

Yes No
Emergency Contact *

First Name Last Name
Emergency Contact Phone Number *
Please enter a valid phone number.
Relationship *
Disclaimer
I give permission to my child, blanks* ,(child name) permission to attend and participate in activities sponsored by Kids at Their Best. I hereby release Kids at Their Best, its employees, associates, and contributors from liability from any injury, loss, or theft incurred by my child while participating. Furthermore, I hereby authorize medical examination and emergency treatment for my child by emergency personnel in the event of an accident. I further understand that Kids at Their Best has an "Open Door" policy, which means that my child may come and go at will. I further understand that doors to the After-School Kids Club close at 5:15 pm. I understand that Kids at Their Best is not utilizing its own building and need to be respectful of the time that they were allotted to use the school. Furthermore, I understand that no Kids at Their Best staff will be present past 5:15 pm. My signature below indicates that I completely understand the above statement.
MEDIA RELEASE: I give permission to have my child's photos used in Kids at Their Best publications, social media, news articles, marketing materials, etc. *

Yes No
When will be your child's first day attending our program? *

Month Day Year
Date
By signing up your child for After-School Kids Club, it is assumed that they will be attending from Monday-Thursday. If there is ever a day that they cannot stay, the parent/guardian is responsible for calling Green Acres and letting them know that their child will not be attending programs that day. *

I understand that I am responsible for calling Green Acres on days when my child cannot attend After-School Kids Club.
Signature *

Clear
Should be Empty:

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

After-School Kids Club Registration

Disclaimer