KidWorks Saturday Registration /Registro de Sabado
Grades K-12th/grados K-12
Student Information/Nombre del estudiante
*
First Name
Last Name
Birthday/Fecha de nacimiento
Grade/Grado
Individualized Education Plan (IEP) / Programa de Educacion Individualizado (PEI)
Please List any allergies/Por favor indique las alergias
Permission to attend KidWorks Field Trips/Permiso para asistir a las excursiones de KidWorks
Student #1/
Estudiante #1
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Yes/Si
No
Yes/Si
No
Student #2/
Estudiante #2
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Yes/Si
No
Yes/Si
No
Student #3/
Estudiante #3
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Yes/Si
No
Yes/Si
No
Student #4/
Estudiante #4
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Yes/Si
No
Yes/Si
No
Student #5/
Estudiante #5
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Yes/Si
No
Yes/Si
No
Home Address/direccion de casa
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Parent's Contact info/Información de los padres
*
First Name
Last Name
Email/correo electrónico
*
example@example.com
Phone Number/Numero de telefono
*
-
Area Code
Phone Number
Emergency Contact info/informacion de contacto de emergencia
*
First Name
Last Name
Phone Number/Numero de telefono:
*
-
Area Code
Phone Number
Relationship to the family/relación con la familia:
*
I agree that my student will agree to abide by the KidWorks Traditions ( 1. Come Prepared 2. Respect 3. Be a leader 4. Have fun) /Acepto que mi estudiante aceptará cumplir con las tradiciones de KidWorks (1. Venga preparado 2. Respete 3. Sea un líder 4. Diviértase)
I agree/De acuerdo
I hereby grant KidWorks Community Development Corporation, its employees and/or agents (collectively, KidWorks) permission to take photographs or video of me, my child(ren) or any family members invited by me to attend any KidWorks-related activity/Por la presente, otorgo a KidWorks Community Development Corporation, sus empleados y / o agentes (colectivamente, KidWorks) permiso para tomar fotografías o videos de mí, mis hijos o cualquier miembro de la familia invitado por mí para asistir a cualquier actividad relacionada con KidWorks
I agree/De acuerdo
In case of emergency, I authorize KidWorks staff to obtain necessary medical attention in case of sickness or injury to my child. I understand that the staff at KidWorks will attempt to contact me before securing medical treatment, but that this consent is given in case I am not available in an emergency./En caso de emergencia, autorizo al personal de KidWorks a obtener la atención médica necesaria en caso de enfermedad o lesión de mi hijo. Entiendo que el personal de KidWorks intentará comunicarse conmigo antes de obtener tratamiento médico, pero que este consentimiento se otorga en caso de que no esté disponible en una emergencia.
Yes/Si
No
I hold harmless KidWorks staff and volunteers from any and all claims, loss, cost, damage, or expense arising out of or from any accident or other occurrences causing injury to any person or property./Mantengo al personal y voluntarios de KidWorks exonerados de todas y cada una de las reclamaciones, pérdidas, costos, daños o gastos que surjan de un accidente u otros sucesos que causen lesiones a cualquier persona o propiedad.
Yes/Si
No
I acknowledge that the information included on this registration is accurate and completed to the best of my ability. /Reconozco que la información incluida en este registro es precisa y completada lo mejor de mis habilidades.
Yes/Si
No
Person completing this form/Este formulario está siendo completado y enviado por.
First Name/Nombre de pile
Last Name/apellido
Today's Date/Fecha
-
Month
-
Day
Year
Date
Submit/Enviar formulario
Should be Empty: