After School Enrichment Clubs 2025-2026 School Year

Enrichment Clubs Form

Use this form to register your learner for afterschool programming at The Kaleidoscope Discovery Center. Have more than one learner? Submit the first, then refresh the form to submit for more.
Your Name (person completing this form)*

First NameLast Name
Your Email*
example@example.com
Your Phone Number*
Please enter a valid phone number.
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Name*

First NameLast Name
Student Birthdate*

MonthDayYear
Date
Student Grade*
What school does this student attend?*

HomeschooledROLLA- Truman ElementaryROLLA- Mark Twain ElementaryROLLA- Wyman ElementaryROLLA- Rolla Middle SchoolROLLA- Rolla Junior HighROLLA- Rolla High SchoolROLLA- St. Patrick's SchoolROLLA- RTI (Rolla Technical Institute)ST. JAMES- Lucy Wortham ElementaryST. JAMES- St. James Middle SchoolST. JAMES- St. James High SchoolOther
Transportation will be an option for Rolla Public School students. When it becomes available, would your student need transportation to KDC?*

When available, I would like my student to be transported.I plan to transport my student to the KDC (even when transportation is available, I won't use it).Other (please elaborate)
Student's phone number (if different than the one you listed for yourself)
Please enter a valid phone number.
Student's address (if different than the one you listed for yourself)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's Additional Emergency Contact Name

First NameLast Name
Student's Additional Emergency Contact Phone Number
Please enter a valid phone number.
Student's Additional Emergency Contact Email
example@example.com
If this student has any allergies, needs special accommodations, or if there is anything else we should know, please list it below.
May we use photos of this student for our marketing purposes?*

Yes, that's fine.No, I don't consent to this.

Hidden to separate months

Hidden to separate months

Hidden to separate months

Hidden to separate months

Hidden to separate months

Hidden to separate months

Hidden to separate months

Hidden to separate months

Total Owed
How are you paying for your student to attend?*

Pay ONLINE with this form (PayPal or Credit Card) *PREFERRED OPTION BY KDC*Check or Cash
I agree that the amount calculated above is correct and will pay it to The Kaleidoscope Discovery Center*

Yes, I agreeNo, I believe it's incorrect. I'll explain below how much I think I owe.
If you believe the amount the form calculated is wrong, please explain and share how much you think you owe below.*
Pay on PayPal or with Credit Card (no PayPal account required)

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Enrichment Clubs Form