IKIDZ LEARNING CENTER (THRONTON
)
www.ikidzlearning.com
After School Registration Form 2020-2021
Student Name
*
First Name
Middle Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
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1999
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1937
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Male
Female
N/A
Grade entering in Fall 2020
*
Choose a Program
*
2 days per week
3 days per week
4 days per week
5 days per week
If your child is in Kindergarten for 2020-2021, then choose the time
*
8:30am to 11:30am
11:30am to 6:45pm
3:00pm to 6:45pm
Combo: 8:30am to 11:30am PLUS 3:00pm to 6:45pm
Child not in Kindergarten
If you chose 2, 3 or 4 day program, enter the days of the week your child will be attending accordingly(days will remain the same through out the year
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade entering in Fall 2020
*
Contact E-mail-1
*
Contact E-mail - 2
*
example@example.com
Phone Number - 1
*
-
Area Code
Phone Number
Phone Number - 2
*
-
Area Code
Phone Number
School Attending
*
Do you require pick up from school?
*
Please Select
Yes
No
IKIDZ After-School Start Date
*
-
Month
-
Day
Year
Date
Parent's Name
*
First Name
Last Name
Emergency Contact Information (other than parents listed in the form) Include Name, Phone number
*
List names of people who are authorized to pick up your child from the center.
*
Physician's Contact Information in case of emergency
*
Any allergies or medical conditions that we need to know about
*
We acknowledge that we have received and read your policies and will comply with it.
*
Yes
No
Please initial below by typing your first name
*
Submit
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