Kidz Connect 2017-18
Kidz Connect is an after school music and missions program for students Kindergarten through 6th grade. Cost of Kidz Connect is $30 per school year. This should be paid in full in September. This includes t-shirt, snacks, special costumes where needed, and music license.
Email address
Student's Name
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Grade Entering
Parent's Name
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Parent's Phone (please list # that text if available)
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Primary Address
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Emergency Contact- Name & Phone (in addition to parent if available)
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Student Allergies
Allergy Information
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In the case of emergency, I give the adults in charge, permission to secure and authorize medical treatment while my child is in their care.
Insurance Information (Please list Carrier, Policy Holder's Name, Group, and Policy #)
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