After School Care Enrollment Form

Kingsview Aftercare Enrollment
Please fill out for all children attending Kingsview after school care.
1st Child's Name:*

First NameLast Name
Gender:*

MaleFemale
Date of Birth:*

MonthDayYear
Date
Tuition*

I understand that tuition for after care is $5 per hour, per child enrolled.
2nd Child's Name:
Gender:

MaleFemale
Date of Birth:

MonthDayYear
Date
Transportation to Kingsview Aftercare Facility:

Kingsview StudentBus from Hillcrest ElementaryBus from North Bay ElementaryParent/Guardian drop off
Please add addition children here:
Parent/Guardian Contact Information:
Mother's Name:
Mother's Email:
Mother's Cell Phone:
Mother's Home Phone:
Mother's Business Phone:
Father's Name:
Father's Email:
Father's Cell Phone:
Father's Home Phone:
Father's Business Phone:
Please state any shared custody, if applicable:
(Divorced/separated with shared bi-weekly custody)
Child's primary Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
First Language spoken at home:
Second Language spoken at home:
Do your children have health issues? If so please describe:
Do your children have allergies? If so list here.
Do your children have any physical, social, or emotional challenges we should be aware of? If so describe here:
Emergency Contacts & Release for Pick ups

I give permission to the following individuals to act as parent designates to pick up my child(ren) from Kingsview Aftercare.
First Emergency Contact's Name*

First NameLast Name
Release for Pick ups*

Yes this person can pick upNo this person cannot pick up
Relationship to Child:*
Cell Phone:*
Home Phone:
Second Emergency Contact's Name*

First NameLast Name
Release for Pick ups*

Yes this person can pick upNo this person cannot pick up
Relationship to Child:*
Cell Phone:*
Home Phone:
Please list the names of the people into whose custody we may dismiss your child(ren). Your children will not be allowed to leave the school with anyone not listed below. You can add people to this list at any time.
Please list others that can pick up here:
Is your child also attending Kingsview Christian School?

YesNo
Please provide any further information relating to your child that would be helpful in understanding and caring for your child:
Payments are DUE at the end of each month.
Payment options will be outline in the monthly confirmation emails.
AGREEMENT: I understand that this form must be completed before my enrolment is considered. I hereby acknowledge that I am aware of the conditions stated in this agreement and agree to abide by these requirements.
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Kingsview Aftercare Enrollment

Parent/Guardian Contact Information:

Emergency Contacts & Release for Pick ups