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2019-2020 School Year Registration Form
*Please fill out the following information in order to register and/or hold a spot for your child at Kids Club. All new families will also need to fill out a paper enrollment packet and immunization forms found on the website.
Email address *
Child's Name (First & Last): *
Your answer
Child's Date of Birth: *
MM
/
DD
/
YYYY
Child's Grade during the 2019-2020 school year: *
Child's school in the fall:
Parent/Guardian Name (First & Last): *
Your answer
Address (please include city, & zip code): *
Your answer
Phone Number: *
Your answer
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