Before & Aftercare Form 2025

Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email For billing receipts*
example@example.com
Best Daytime Emergency Contact Number*
Home Street Address*
City
State
Zip Code
School Attending
I am Enrolling my child in*

Before Care Only $85 Paid weeklyAftercare Only $135 Paid weeklyBefore & Aftercare $155 Paid weeklyDrop In Camp Days Only $60 per day - pay as you attend
2025 - 2026 GRADE*

GRADE KGRADE 1GRADE2GRADE 3GRADE 4GRADE 5GRADE 6GRADE 7GRADE 8
For Aftercare Services Please Choose your Child's School

Windmill PointManatee AcademyOak HammockPalm Point,St Lucie WestMorningside ElementarySomerset PSLBayshore Elementary,Somerset @ BethanySomerset CPARenaissance TraditionAllapattah FlatsWestgate
For Before & Aftercare Services Please Choose your Child's School

Windmill PointManatee AcademyOak HammockPalm Point,St Lucie WestMorningside ElementaryBayshore Elementary,Westgate
For Before-care Services only Please Choose your Child's School

Windmill PointManatee AcademyOak HammockPalm Point,St Lucie WestMorningside ElementaryBayshore Elementary,Westgate
Parents/Guardians Contact Information
Parents / Guardians Names *
Address if different from above
City
State
Zip Code
Parent 1 Name*
Parent 1 Cell*
Parent 1 Work
Parent 2 Name
Parent 2 Cell
Parent 2 Work
Tell us about your child Every child is unique please use this space to fill us in on any concerns you may have and also make us aware of any behavioral or developmental issues affecting your child in order to better assist us in caring for himher
Allergies/Medical Conditions:
Please check if your child has any of the following allergies
Please list any allergies or Dietary Restrictions your child has
Release For Pick Up

Please name 3 people in addition to Guardians listed on the first page, who may sign out your child from our center without prior written permission. These individuals will be allowed to remove your child from our care without contact from you, after showing a valid driver's license. (Id will be required)
1. Name
Relationship to Child
2 Name
Relationship to Child
3 Name
Relationship to Child
No Contact Order/ Custody Information

Please notify the Director in writing of any persons who are to have no contact with your child. Please include a copy of any No Contact Order per any court decision. This includes custody disputes. By signing below, you state that that you have read and agree to the rules and conditions outlined in the Kid Space Summer Camp Policies and Procedures.

MEDIA RELEASE

I understand that both still and video images may be taken of my child and may be used in advertising material or on Kid Space/ Sochin Martial arts/Wish Me Luck Farms websites, as well as posted to our Facebook or Instagram.
ParentGuardian Signature*

Powered by Jotform SignClear
Date

MonthDayYear
Date
THIS IS A CONCTRACTED SERVICE

Kid~Space 2025/2026 Afterschool Enrollment Contract

I understand that by registering my child (children) for

Aftercare____ or Before & Aftercare or ____ Before care only ____

I am entering into a binding contract with Kid Space LLC. Tuition is due regardless of attendance or circumstance.

Total Number of Weeks Semester 1 August 11 - December 19, 2025 is 19 weeks.

Total number of weeks Semester 2 January 5 - June 5 is 22 weeks

No credits will be given for absences. Students are guaranteed space only for those weeks reserved in

Payment Policy

I understand tuition is paid ahead. Payments are due on Fridays, for the upcoming week. Payments

not made by Monday at 6:30pm will be considered late, and subject to a $20 late fee. This fee will be added to my account and charged to my credit card on file.

Late Pick Up Fees

I understand Kid~Space Summer Camp is open from 6:30 am until 6:30pm.

A $1 a minute late fee will apply after 6:35pm. This fee will be added to my account and charged to my credit card on file.

I have read and understand the Kid~Space contract. I agree that my credit card may be charged in the event I do not make payments as specified in this contract.

I understand that my card may be charged weekly for any outstanding fees owed on my account, including tuition, late fees, returned check fees.

A Master Card or Visa card must be held on file toto sign up for auto pay.
Kid Space Camp Field Trip/Medical Release Form

As the parent/guardian of {studentsName} I hear by grant consent for him/her to participate in Kid Space approved field trips while enrolled in Spring Break or Summer Camp from August 1, 2025 - August 10th, 2026. I have been advised in writing or by verbal notification of all trips available to my child over the course of the summer, including destinations, dates and travel arrangements.

It is my understanding that Kid Space will advise me by written or verbal notification of any changes to the posted schedule in sufficient time to enable me to communicate any withdrawal of consent for the specific trip or activity. Trip changes will be posted in the front lobby.

I understand that Kid Space LLC and it's subsidiaries will be held harmless from any damages or claims that might arise from injuries out of any act or omission on the part of Kid Space as a result of such a trip or activity.

I understand that travel arrangements for my child include walking to locations within reasonable distances, such as other businesses in our plaza. When walking students will remain on sidewalks and off main roads. When driven my child will be in a Kid Space approved vehicle and driven by an approved driver. AlthoughKid Space vans will be the primary transportation, approved chaperoning parents will be allowed to transport my child as well with prior verbal notification.

As the parent/guardian of the above named student, I hear by give authorization to the staff of Kid Space LLC to transport my child to the nearest emergency room if for any reason they require minor medical treatment. I understand that emergency medical personal may be called to transport at the discretion of the director. I further authorize the hospital it's medical staff to administer treatment as deemed necessary for the well-being of said student. I understand that the staff will make every attempt to notify me in all medical emergencies, and I will be contacted if possible for my permission if hospitalization or treatment of a serious nature is required. I have read and understand the above and freely give my consent and permission of all things contained
ParentGuardian Signature*

Powered by Jotform SignClear
Date

MonthDayYear
Date
Childs Date of Birth*

MonthDayYear
Date
Childs Weight*
ParentGuardian Contact best daytime number*
I have read and understand the Kid~Space contract. I agree that my credit card may be charged in the event I do not make payments as specified in this contract. I understand that my card may be charged weekly for any outstanding fees owed on my account, including tuition, late fees, returned check fees, or unpaid lunch fees.
Signature*

Powered by Jotform SignClear
Date

MonthDayYear
Date
PAYMENT INFO :

Payment is due with submission of registration.

There is a OPEN AMOUNT pay link available at the end of this form. or you may send Zelle to 772-340-2140, or pay in person at the fron office.

AfterCare Only is $135 per week

Before & Aftercare is $155 per week

Before Care Only is $85 per week

Siblings receive a $10 discount per second child per week

New Students or returning students who did not attend the 2024/2025 school year Please pay $40 Reg fee ($65 per family) plus your first week to hold your spot.

Current students who were enrolled this past school year do not need to pay a registration fee. Please pay the first week's tuition with your form.

Auto Pay: If you would like to use our Auto pay service Please set up Auto Pay seperately in the fornt office after submiutting this form with payment.

Should be Empty: