KULC Enrollment Form

KIDS UNLIMITED LEARNING CENTER INC ENROLLMENT FORM
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Parent's or Guardian's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Emergency Contact 1*

First NameLast Name
Phone Number*
Emergency Contact 2

First NameLast Name
Phone Number
Please enter a valid phone number.

FAMILY HANDBOOK
CLICK HERE TO DOWNLOAD PARENT HANDBOOK
I have downloaded the Kids Unlimited Learning Center Parent Handbook. I have reviewed and accept all policies stated within the document.*

I ACCEPT

I agree to pay weekly tuition for age below:*

$210 Age 18-23 months$195 Age 2$175 Age 3-5ELC Voucher Parent Fee (varies)

MEDICAL/DIETARY QUESTIONS
Physical Condition: Please list any non-allergy physical/medical conditions that would be helpful for us to know about this child. *
Food Requests: Please indicate any dietary requests due to your child’s preferences, religious practice, lactose intolerance, food sensitivity, or treatment for a behavioral condition. The following requests are NOT due to a food allergy:*
Allergies: Has your child been tested and diagnosed for a food allergy by a health care professional? Is yes, please state the allergies below.*
Authorized Pick Up
The following people are authorized to pick up your child from the center in non-emergency situations. Anyone other than the listed people must be called in or message sent on the portal to make us aware. Everyone will be asked to provide a photo ID.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
LIABILITY WAIVER

I hereby release and agree to indemnify, defend and hold harmless Kids Unlimited Learning Center, and their officers, agents, employees and affiliated businesses from and against any and all claims, liabilities, actions, judgments, damages and injuries of any kind and nature whatsoever arising out of or in connection with the provision of child care and educational services for my child including all releases signed throughout the enrollment paperwork.
I HAVE READ THE AGREEMENT, FULLY UNDERSTAND IT, AND GRANT PERMISSION FOR MY CHILD TO ENROLL IN THE PROGRAM IDENTIFIED ABOVE.

Date*

MonthDayYear
Date
Signature of Parent or Legal Guardian:*

Powered by Jotform SignClear
Should be Empty:

KIDS UNLIMITED LEARNING CENTER INC ENROLLMENT FORM

FAMILY HANDBOOK

PROGRAM DETAILS

Authorized Pick Up