2017-2018 Kaleidoscope Application
Child's First Name: *
Your answer
Child's Last Name: *
Your answer
Child's Preferred Name:
Your answer
Child's Birthday:
MM
/
DD
/
YYYY
Child's Gender:
Parent First/Last Name: *
Your answer
Parent Cell: *
Your answer
Parent Email: *
Your answer
Emergency Contact (Name & Phone Number):
Your answer
Special Requests/Anything About Your Child You'd Like to Share:
Your answer
Please Select Class: *
Registration Options
Kaleidoscope - 9:45am-2:00pm
Includes: Spanish Immersion, Champs Enrichment, & KidSpark Gymnastics
*
Add Kid Spark Early Bird Drop-Off (9:00-9:45am)?* *
*By choosing an Early Bird option, I (the parent/guardian) am authorizing Kaleidoscope staff to pick up my child from Kid Spark and sign them into the Kaleidoscope Class. Please Initial below. *
Your answer
I have read and agree with Champions Westlake policies and authorize Champions Westlake to manually enroll my child in the Kaleidoscope Early Learning Program for the specified days and times in this application. I also understand that upon enrollment I will be charged the annual enrollment fee & supply fee of $175, Half month’s tuition* (non-refundable) *This deposit will be applied to the May 2018 installment . The first month’s installment will be due August 1st. Please initial.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms