Spring - Fall registration form (new students) 2023-2024

Family Information
Parent 1 Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 1 cell phone*
Please enter a valid phone number.
Parent 1 Employer*
Parent 1 Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 1 Work Number*
Please enter a valid phone number.
Email*
example@example.com
Parent is authorized to pick up child*

YesNo (court documents required)
Parent 2 Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 2 cell phone*
Please enter a valid phone number.
Parent 2 Employer*
Parent 2 Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 2 Work Number*
Please enter a valid phone number.
Email*
example@example.com
Parent is authorized to pick up child*

YesNo (court documents required)

Child Information*

	Birthdate	Gender	Classroom	Schedule	Date of Admission	Child's shirt size	Child's Name
Child 1 Name
Child 2 Name
Child 3 Name
Child 4 Name

Please upload a signed copy of your child's immunization records (Infant-Pre-K only). This cannot be a download from MyChart-must be signed by the physician.*

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Please upload a signed physician statement (Infant-Pre-K only). Please contact the office (spring@kidsinaction.net) or Enrollment Director (enrollment@kidsinaction.net) for a copy of the form.*

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SCHOOL AGE ONLY, Please list child's grade level and school
SCHOOL AGE ONLY: My child attends the following school and his/her immunization record is on file at the school and all required immunization test are current. Vision and hearing screening records are also on file.

Birnham Woods Elementary (31150 Birnham Woods Dr, Spring, TX 77386, 832-663-4200)Snyder Elementary (28601 Birnham Woods Dr, Spring, TX 77386, 832-663-4400Bradley Elementary (4200 Falls Lake Dr, Spring, TX 77386, 832-482-6800)Kauffman Elementary (2760 Northridge Forest Dr, Spring, TX 77386, 832-592-5600)Broadway Elementary (2855 Spring Trails Bend, Spring, TX 77386, 281-465-2900)Hinse Elementary (4500 Lexington Blvd, Spring, TX 77386)Not in school. Immunization records to be provided by parentOther

Emergency contacts and authorized pick ups*

	Full Name	Address	Contact Number	Relationship
1
2
3
4

I give my permission for my child(ren) to be transported to and from school (if applicable)

Yes
I give permission to receive periodic text messages in case of emergencies and/or school closures*

Yes
I understand that I am financially responsible for tuition if I do not give a full 2 week notice in writing upon withdrawal*

Yes
My child has permission to be released to the care of a sibling under the age of 18 years old*

YesNo
If yes to the previous question, please list the siblings name(s).
Emergency Medical Care: I authorize Kids in Action, in an emergency, to act in my behalf for my child's sake and to have my child transported to the nearest medical facility*

Yes
Child's Pediatrician Name*
Child's Pediatrician Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Pediatrician Phone Number
Please enter a valid phone number.
I understand that I may not bring my child to Kids in Action when he/she is exhibiting any of the following: a temperature over 100.3 or more bouts of diarrhea or vomiting, any undiagnosed rash, or sore, or discharging eyes or ears, or profuse nasal discharge. If my child is sent home, they must remain out a minimum of 24 hours and cannot return until they are symptom free and unmedicated for at least 24 hours.*

Yes
I understand that Kids in Action staff will only administer medication under the certain conditions: 1. Only if your child needs 3 or more doses and Kids in Action will administer the middle dose only. The only exception is if the medication needs to be taken at a certain exact time, such as ADD medication for an after-school child. 2. Medicine is accompanied by a medication form that must be signed by the parent/legal guardian (available upon request at the front desk).*

Yes
List any and all previous illnesses, broken bones, surgeries, etc*
Are there any restrictions on normal activities? If so, please explain*
Is your child physically and mentally able to participate in group activities?*

Yes
Is your child free from infection and contagious disease?*

YesNo
I understand that there is always some risk of injury due to accident whild children are playing together and that unless any injury is a direct result of abuse or obvious negligence by Kids in Action employees, I will not hold Kids in Action or its employees responsible*

Yes
Does your child have any special needs the staff needs to be aware of (ADD, Autism, Epi-pen, speech, etc)? If so, please send a copy of the child's IEP and a copy of the Kids in Action allergy form signed by a doctor.*
List any known allergies or medications (allergy form must be completed and returned to be kept on file).*
I understand that my child will participate in Outdoor Curriculum and will: get muddy(please wear appropriate clothes on classroom's day), be tasting veggies/fruits/herbs that they grow, will be engaging in more risky play (moving rocks, building with sticks; playing in the rain, utilizing hammers and garden tools for certain activities, handling bugs, being around bees. (Please type your name in acknowledgement)*

Please check all of the permissions that you agree to for your child(ren):*

	Yes	No	N/A
Play and participate in all on-site activities
Play on the outdoor playground/slack line (age appropriate)
Watch movies at the center that staff select (rated G or PG)
Play video games that are age appropriate
Participate in water activities (sprinklers, water hoses, water slides and slip and slide)
Swimming in the onsite pool w/certified lifegaurd on duty (school age group ONLY)
Take outdoor stroller rides (infants, waddlers, and older tots ONLY)
Have lotion applied to hands after washing (infants, waddlers, and older tots (ONLY)
Have diaper cream applied during diapering (infants, waddlers, and older tots ONLY)
Participate in Archery Course (school age group ONLY)
Participate in Razor drifting trike activities (school age group ONLY)
Participate in Ninja Warrior and Nerf Wars (school age group ONLY)
Have KIA bug spray/sunscreen applied as needed (NO-AD SPF 50 & Cutter Sensations w/DEET) required unless we have doctor's note
Be included in pictures connected with the center's program to be used in-house or on closed Facebook class page
Use my child's picture for advertising purposes (ie: Kids in Action Facebook page or Website)

I have read and understand Kids in Action's policy on discipline and guidance*

	Yes
Discipline must be: individualized and consistent for each child, appropriate to the child's level of understanding and directed toward teaching the child acceptable behavior and self control
A caregiver may only use positive methods of discipline and guidance that encourages self-esteem, self-control and self-direction which include at least the following: using praise and encouragement of acceptable behavior instead of focusing on unacceptable behavior, redirecting behavior using positive statements, reminding children of behavior expectations daily using clear and positive statements and using brief supervised separation or time out from the group, when appropriate for the child's age and development, which is limited to no more than one minute per each year of the child's age
There must be NO harsh, cruel or unusual treatment of any child. The following types of discipline and guidance are PROHIBITED: corporal punishment or threats of corporal punishment, punishment associated with food, pinching, shaking or biting a child, hitting a child with hand or instrument, putting anything in or on a child's mouth, humiliating, ridiculing, rejecting or yelling at a child, subjecting a child to harsh, abusive or profane language, placing a child in a locked or dark room, bathroom or closet with the door closed and requiring a child to remain silent or inactive for inappropriately long periods of time for the child's age.
All of the above are in accordance with Texas Administration code, title 42, chapter 746-747, subchapters L, discipline & guidance

I have read and understand Kids in Action's policy on termination for cause.*

	Yes
Children: bullying, defacing and/or destroying center property or the property of others, engaging in aggressive behavior toward other children and/or staff members including, but not limited to: spitting, yelling, hitting, kicking, being rude and/or discourteous to any staff member, using foul language on the premises, stealing from the center, staff or other children, refusing to remain with assigned group, horse playing in the swimming pool or on a field trip
Parents: engaging in aggressive behavior toward a child and/or staff member of the center, failure to call if child's schedule changes that affect drop off/pick up from school, failure to follow check in/out procedures, using foul language on the premises, being rude and/or discourteous to any staff member, failure to provide the necessary enrollment forms and/or information to the center and failure to pay accurate and current fees. All fees are due the Monday before the following camp week. Any fee not paid by the 2nd day following the schedule payment day, will be charge a late fee payment of $15. NO EXCEPTIONS

(School age only) - HOMEWORK CONTRACT - Kids in Action staff dedicate a time Monday-Thursday for the kids to start/complete their homework. Once we move on to the next activity, the kids will have the opportunity to sit out of the activity to complete their homework if they choose. The staff cannot force the kids to do homework or require them to sit out if they refuse, but they are available for any assistance the kids might need. If they do not start and/or finish their homework, we must move on to the next activity. Please indicate what you would like your child to do with regards to homework in our program:*

My child does not need to start his/her homework at Kids in Action. I prefer that they complete their work at home.Please encourage my child to at least start his/her homework.My child needs to complete his/her homework before coming home from Kids in Action. **If your child states that he or she does NOT have any homework on a given day, they will sign a contract stating that they have NO homework, to be turned in to the parent.
By typing my name below, I acknowledge and agree that all the information is true. I agree to abide by the policies listed in this form*
Please upload a clear picture(s) of your child(ren) so we can add it to their account (you can upload more than one picture for multiple children:*

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Other school if not listed above (school address and phone number)

Fall 2023-2024 Tuition agreement
Payment for my child's program is due on MONDAY of the current week. Tuition is due whether my child attends or not. All accounts must be set up on automatic payment plan for tuition. Tuition will be deducted out of checking accounts. A $15/day late fee will be added if not paid by the end of business on Monday. If tuition and/or late fees are not paid by Friday, then I understand that my child cannot return to care the following Monday until paid. A $10/week discount will be given to all accounts who use a checking/savings account for auto charge payment (please type your name)*
Type a question
If paying monthly, tuition weeks are counted by the number of Mondays in a month. I understand that there are THREE months during the school year that have FIVE Mondays (October '23, January '24 and April '24). Please make note an additional week will be charged, so you are not surprised when it happens (please type your name)*
If paying yearly, I will receive a 3% discount. If I choose to end my relationship with Kids in Action before the end of the year, I will be refunded 75% of the remaining tuition over a 3-month time span (please type your name)*

INCLEMENT WEATHER, PANDEMIC OR OTHER RELATED CLOSINGS: Kids in Action follows Conroe ISD closings. Please check local TV stations and web sites for announcement of closing. Full tuition is due during inclement weather times. If extended circumstances exist, such as a flood or pandemic, where the center is closed for an extended amount of time, then the following tuition policy will apply*

	Please check each box below
INCLEMENT WEATHER, PANDEMIC OR OTHER RELATED CLOSINGS: Kids in Action follows Conroe ISD closings. Please check local TV stations and web sites for announcement of closing. Full tuition is due during inclement weather times. If extended amount of time, then the following tuition policy will apply:
After 3 weeks, 50% tuition will be due until the child returns
If you choose to withdraw your child, a 2-week notice and full tuition is required. After 2-weeks, your child's spot will not be held and a new registration fee will be required to re-enroll, if openings remain

If Kids in Action is closed and children are unable to attend, then the following tuition schedule is applied*

	Please check each box below
Full tuition is due for 3 weeks following the closure
50% tuition will be deducted for 3 weeks following
After 6 weeks of closure, no tuition will be collected and the children's spots will be held
I case of serious emergencies such as earthquake, fire storms, or loss of power/water, parents will be notified, if possible and child will be cared for until parents or emergency contacts arrive.

In the event of a NSF check/ACH return, a $35 penalty fee will be added to my account. If Kids in Action receives 3 or more NSF checks/ACH return in one year, your enrollment may be terminated (please type your name)*
Kids in Action is licensed by the Texas Department of Family and Protective Services. Operating hours are Monday-Friday from 6:30 am to 6:30 pm and we can only care for children during these specified times. A late fee of $10 for the first 10 minutes and an additional $1 per minute will be charged to your account (please type your name)*
In the event your child forgets his/her KIA t-shirt on a field trip day, a $15 charge will be applied to your account (please type your name)*
I understand a $60 per child Fall Semester Supply Fee and $75 per child Spring Semester Supply Fee will be applied to my account in August 2023 and January 2024 (please type your name)*
Each June, a tuition increase goes into effect. The rate varies year to year, based on Cost of Living expenses, as well as other factors (please type name)*
Proper attendance tracking is imperative to the safety of the children enrolled. All parents are required to sign their children in and out each day. When a family fails to sign their child in or out, a $5 penalty fee will be applied to your account for each occurrence (please type your name)*
A $15 fee will be imposed if you do not call or email BEFORE NOON and let the office know your child WILL NOT be on the bus after school. This can delay the driver from staying on schedule and being late for the next pick up (please type your name)*
All tuition payments are payments to hold the child's space in the program. Tuition is due regardless of attendance. (please type your name)*
We offer Holiday Camps for pre-school and school aged children. Camp tuition rates will apply. You need to sign your child up for all holiday and summer camps, if you will need them to attend. Spots are limited and sign up is first come/first serve as we open them to the community. Current enrollment doesn't guarantee a spot should you fail to register. We give ample reminders ahead of time. Tuition is due regardless of attendance. (please type your name)*
If at any point my account becomes delinquent, I understand that any credits or discounts will be removed from my account (multiple child discount, First Responders, etc.) (please type your name)*
Kids in Action chooses not to get involved in custody disputes. In the event a court order is on file, Kids in Action will not acknowledge which party is responsible for payment of tuition fees. These arrangements must be coordinated between the two parents. Late fees and withdraw guidelines will still apply regardless of which parent is responsible for tuition fees (please type your name)*
If I choose to end my relationship with Kids in Action and withdraw my child, a 2-week notice will be given in writing. I understand that I am financially responsible for tuition if I do not give a full 2 week notice in writing upon withdrawal (please type your name)*
I understand that the registration fee in non-refundable (please type your name)*

Registration

The registration fee must be paid in full in order to secure placement
My Products
prevnext( X )
Yearly registration fee (1 child)
$200.00 Quantity



Yearly registration fee (2 or more children)
$300.00 Quantity



Yearly registration fee (Staff/Subsidy)
$ Free Quantity



Total

$0.00
Please upload a copy of the direct deposit form (ACH or credit card)

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Recurring payment set-up

ACH payments receive a discounted weekly rate over card payments. Tuition is charged weekly or bi-weekly on Mondays. Families may also pay monthly.
I would like to pay tuition*
How did you hear about us?*
If a family referred you, who can we thank?
Should be Empty:

Family Information

Fall 2023-2024 Tuition agreement

Registration

Recurring payment set-up