Before/After School Care Registration

Before/After School Care

Kids Club Thalwil
Information of Child
Name*

First NameLast Name
Birth Date*

DayMonthYear
Grade
Gender

FemaleMale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Second Child *Optional
Name

First NameLast Name
Birth Date

DayMonthYear
Grade
Gender

FemaleMale

Before/After Care Dates and Times
Do you require before or after school care?

Before schoolAfter school
Days of the week required

MondayTuesdayWednesdayThursdayFriday
Select Time

Information of Parent
Information of Parent
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Emergency Contact 1
In the event of an emergency, please contact:

Emergency Contact
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Other people authorized to pick up child from facility
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns.
Should be Empty: