2024 AFTERSCHOOL Registration Form

2024-2025 AFTERSCHOOL

Starts AUGUST 13, 2024 - FEE $199.00 per week (NO daily fee)
Student Information
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Home Number
Cell Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
SCHOOL INFORMATION
Your child will be transported or pick up at the following school*
Child's Grade Level*

Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th GradeOther
Elementary | Middle School School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Phone*
Please enter a valid phone number.
MEDICAL INFORMATION
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the student prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby provide my consent for my child to participate in all activities organized by KIMS USA during the Afterschool or Camp program. By accepting my child's enrollment in the program, I acknowledge and accept all risks and hazards associated with the activities. I release, discharge, and hold harmless KIMS USA, along with its officers, agents, and representatives, from any and all liability for injuries sustained by my child while traveling to, participating in, or returning from selected Afterschool or Camp sessions.

In the event of injury to my child, I waive all claims against KIMS USA, including its coaches, affiliates, participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used for the event. I understand that sports activities, including but not limited to taekwondo, gymnastics, or any other sports practiced at KIMS USA during Afterschool or Camp, carry inherent risks of injury such as fractures, paralysis, or death.

Additionally, I agree to adhere to all KIMS USA policies, whether they are communicated verbally, provided in writing, or posted. It is understood that KIMS USA maintains a strict NO REFUND policy.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

2024-2025 AFTERSCHOOL

Student Information

SCHOOL INFORMATION

MEDICAL INFORMATION