2024-2025 KASPER Registration: New Participants

Account Email

Enter only one email address for account. Account email will be used for receipts, invoices, ePact and program communication.
Email*
example@example.com

Child's Information
Children requiring medication during program hours must have an authorization form completed through ePACT.
American with Disabilities Act: Special Needs?*

YesNo
List medical condition/disability/diagnosis for child:
List necessary accommodations for your child:
Request an NWSRA aide:*

YesNo

Emergency Contacts

Contacts authorized to pick up child (other than legal guardian's listed previously)
Emergency Contact #1
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Relationship to child:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Emergency Contact #2
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Relationship to child:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Emergency Contact #3
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Relationship to child:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.

Signatures and Authorizations
Check below to confirm:*

I have read the informational flyer and family handbook on our website.
Click Here for link to KASPER page.
Check below to confirm:*

To complete registration, I will register my child for the $45 registration through my park district account within 24 hours of submitting my registration form. If I do not register child via the registration fee, I will forfeit my spot.
Click here for link to KASPER Fees Registration.
Barcode #53330 will be used to pay the KASPER fees registration. The KASPER office will contact you if we are unable to place your child in the program requested at this time. If we can place your child, you will receive an email confirmation/receipt within 14 - 21 business days.
Select only one:*

I want to enroll in autopay for my monthly KASPER payments starting August 1 through April 1. The KASPER office will call the main contact phone number provided to complete setting up autopay at the time of registration.I want to make my payments monthly by the 1st of the month (no automatic payments).
Guardian (1) Signature*

Clear
Guardian (2) Signature

Clear
Information pertaining to this registration and any/all changes will be made available only to the person(s) whose signature(s) appear on this form. This includes account statements, changes and all account information.

Please complete a separate registration form for each child.

A separate, original submission must be completed for each child participating in KASPER.
Should be Empty:

2024 - 2025 KASPER Registration: New Participants