New Student Enrollment Forms

New Student Enrollment Forms
This form, when completed and approved by the director of KDBCC, shall serve as a binding agreement between the parent and student. This document is subject to review by the KDBCC director at any time.
First
Middle
Last
Current Address
Apt#
City
State
Zip Code
Child's Date of Birth

MonthDayYear
Date
Sex
Student Grade
Student School Name
Primary Guardian
Secondary
Address

Address

Street Address Line 2

CityState

Postal / Zip Code
Zip Code
HomePhone
Cell Phone
Employer
Work Phone
Custody Details: Mother
Father
Both
Other
Specify
Emergency Contact: Name
Phone
Parental Release Form
*Student(s) will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the student in case of illness, accident or emergency, if for some reason the custodial parent(s) or legal guardian(s) cannot be reached:
Name
Relation to Child
Phone Number 1
Phone Number 2
Address

Address

Street Address Line 2

CityState

ZipCode
Name
Relation to Child
Phone Number 1
Phone Number 2
Address

Address

Street Address Line 2

CityState

ZipCode
Name
Relation to Child
Phone Number 1
Phone Number 2
Address

Address

Street Address Line 2

CityState

ZipCode
Special Instructions
Medical Information
Student's Physician
Phone
Address
City
State
Zip Code
Hospital Preference in Case of Emergency
Covid Information
Although it is not required for admission to our program, please provide Covid Vaccination Information for your child.
Vaccine
Date Vaccinated

MonthDayYear
Date
Miscellaneous
List all known allergies
Special medical or dietary needs
Disabilities/504 needs
Parent(s)
Date

MonthDayYear
Date
Parent Signature

Clear
Date

MonthDayYear
Date
Director Signature

Clear
Should be Empty:

New Student Enrollment Forms

Parental Release Form

Medical Information

Covid Information

Miscellaneous