KEA 2025-2026 School Year Registration

2025 - 2026 Registration Form

KIKIFER'S Entrepreneurial Academy
Student Demographic Information
Parent / Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Do you need to add a Parent/Guardian
Parent / Guardian Name

First NameLast Name
Address if different from above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
How many students are you registering today?
Registering 6 or more students please email info@kikifersacademy.org
Student 1 Full Name

First NameLast Name
Student 2 Full Name

First NameLast Name
Student 3 Full Name

First NameLast Name
Student 4 Full Name

First NameLast Name
Student 5 Full Name

First NameLast Name
Student 1 Date of Birth

MonthDayYear
Date of Birth
Student 2 Date of Birth

MonthDayYear
Date of Birth
Student 3 Date of Birth

MonthDayYear
Date of Birth
Student 4 Date of Birth

MonthDayYear
Date of Birth
Student 5 Date of Birth

MonthDayYear
Date of Birth
Student 1 last grade completed
Last grade completed
Student 2 last grade completed
Last grade completed
Student 3 last grade completed
Last grade completed
Student 4 last grade completed
Last grade completed
Student 5 last grade completed
Last grade completed
Based on the chart above does your student(s) qualify for free or reduced lunch?

Student's academic information
KEA is coordinating an after school program for the 2025 - 2026 school year. Would you be interested in your student(s) attending if the cost is $25 / week or less?
Is / Was your student currently enrolled at KEA for the 2024 - 2025 school year?
Please choose an option that best describes your student(s):

Emergency Information
Emergency Contact

First NameLast Name
Emergency contact phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to student(s)
Please list any health issues (in none write N/A)
Please list any allergies (if none write N/A)
Insurance Carrier Name
Insurance Policy #
KEA, its employees, and its staff has permission, in the event of an emergency and in case we are unavailable, to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat my child(ren),
KEA has permission to photograph and video record my child(ren) for promotion and (or) school purposes.

Signature
DISCLAIMER

We at KIKIFER’S Entrepreneurial Academy feel it is important for parents and guardians to understand our financial policies and their financial obligations in regards to their student(s) tuition. These policies are published in the KEA Parent – Student handbook.

Signing below is acknowledgement of your Financial Responsibility; and that you have downloaded, read, understand, and agree to the terms and conditions as set forth in section 7. Financial Policies, of the KEA Parent – Student Handbook.

Download Parent - Student Handbook Here!
Who is financially responsible for the tuition bill of the student(s) [Sign and date below] Financially responsible person - 1

First NameLast Name
Add a financially responsible person
Who is financially responsible for the tuition bill of the student(s) [Sign and date below] Financially responsible person - 2

First NameLast Name
Date

MonthDayYear
Date
Financially responsible person - 1
Financially responsible person - 2
Should be Empty:

2025 - 2026 Registration Form

Student Demographic Information

Student's academic information

Emergency Information

Signature