Student Intake Form

2026/2027 KC Monarch Academy Student Intake Forms

Student Intake form for KC Monarch Academy. Complete all sections in one continuous flow. All fields are mandatory.
Student Information
Student full name

First NameMiddle NameLast Name
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student email address
example@example.com
Student mobile phone
Please enter a valid phone number.Format: (000) 000-0000.
Student Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Information
Parent/Guardian Full Name

First NameMiddle NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Additional Parent/Guardian Full Name

First NameMiddle NameLast Name
Additional Parent/Guardian Email
example@example.com
Additional Parent/Guardian Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Electronic Signature
Emergency Contacts
Emergency Contact Entries
Additional Notes or Instructions
Medical Information and Insurance
Primary care physician
Physician phone number
Please enter a valid phone number.Format: (000) 000-0000.
Medical conditions or history

Other
Current medications
Allergies and reactions
Health insurance provider
Policy holder or member ID
Front picture of their insurance card

Cancelof
Back picture of their insurance card

Cancelof
Medical Authorization
Parent/Guardian Signature
Vehicle and Student Driver Permission
Will the student drive a vehicle to campus or program activities?
For those with vehicles, does your son have permission to have passengers in his car?
For those without a vehicle, does your son have permission to be a passenger in a car with a teammate bringing a vehicle?
Want us to know any more details?
Vehicle make
Vehicle model
Vehicle license plate number
Front picture of their driver's license

Cancelof
Back picture of their driver's license

Cancelof
Technology Use and Acknowledgement
Food and Beverage Questionnaire
Name

First NameLast Name
DOB

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Food Allergies

Other
Any Religious Food Accommodations
Favorite Place to Eat
Favorite Food
Favorite Dessert
Does the student cook?
If so, how many times a week do you cook?
What are your favorite things to cook?
What pieces of equipment have you used in your home?
Media Release
I grant permission for my student’s photo, video, and other media to be used for school-related purposes
Parent/Guardian Signature
Liability Waiver
Signature
Should be Empty:

2026/2027 KC Monarch Academy Student Intake Forms

Student Information

Parent/Guardian Information

Emergency Contacts

Medical Information and Insurance

Medical Authorization

Vehicle and Student Driver Permission

Technology Use and Acknowledgement

Food and Beverage Questionnaire

Media Release

Liability Waiver