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Child Information

Please fill out the following information about your child
Child's Name (1) *

First Name Last Name
Child's Name (2)

First Name Last Name
Child's Name (3)

First Name Last Name
Child's Gender (1) *

Male Female
Child's Gender (2)

Male Female
Child's Gender (3)

Male Female
Child's Grade *
Enter grade for each child separated by a comma
School Name *
School Name
Transportation Needed ? (Additional Fee) *

Yes No
Allergies *
Type the name for the child and their allergy
Parent/Guardian Information

Please fill out the following information about yourself
Parent/Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
Emergency Contact

Please fill out the following information for a contact in case of emergencies
Emergency Contact Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Consent Information

Please sign the consent information below
Consent Agreement:

I give permission for my child, to participate in all sponsored activities of Prosperous Kids, Inc. Including trips away from the facility's premises throughout the current year. I understand that there are risks/dangers involved with participating in off-campus trips and their associated activities. In consideration of my child(ren) being allowed to participate in these events, I assume responsibility for those ordinary and reasonable risks associated with the travel and activities. I agree to hold harmless Prosperous Kids, Inc., its affiliated organizations, employees, agents and representatives, including volunteers and other drivers from any and all claims arising from child's participation. This release does not apply to claims of intentional or criminal misconduct of gross negligence by Prosperous Kids, Inc., employees, agents and representatives, including volunteers and drivers.
By choosing I understand, you consent to the terms above *

I understand and agree to the terms above
Child's Name *

First Name Last Name
Parent/Guardian Signature *

First Name Last Name
Policy and Guidelines

Please fill out the following information noting that you have read and understood the policies and guidelines of this company.
1. Payment is due the first day your child starts camp. Then payment is due every Friday before service is rendered.

2. Camp hours are 6:30 am to 6:30 pm. There is a 10-minute grace period, but after 6:40 pm a $10 late fee needs to be given to the person that stayed after hours with your child, and $10 every 15-minutes thereafter.

3. All registration fees are non-refundable.

4. All payment arrangements need to be handled with the office manager before payments are due.

5. If payment is not made on Monday a $10 fee will need to be added, $20 fee if paid on Wednesday – Friday of that week.

6. Three of more days, is a whole week. Half price if less than three days for care.

7. Seat belts are to be worn in every vehicle.

8. T-shirts are to be worn on every field trip.

9. Please call 1-hour ahead of time to cancel any pick-ups or drop-offs. $10 will be added if the driver makes a blank trip or return trip. 10. Our 3-Step Rule – If child is being disruptive, they will get a (1) Verbal warning, (2) Written warning, (3) Parental conference, then asked to leave our program.

11. Only one returned check is allowed, a $25 NSF fee will need to be paid and PK/PC will not accept another check, CASH ONLY!
By choosing I understand, you consent to the terms above *

I understand and agree to the terms above
Parent/Guardian Signature *

First Name Last Name
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Child Information

Parent/Guardian Information

Emergency Contact

Consent Information

Policy and Guidelines