Kids Unite Enrollment Form
2019-2020 After-School Child Care
Email address *
Name of Student
Your answer
Male or Female
Grade level for 2019-2020 school year
Date of Birth of Student
MM
/
DD
/
YYYY
Name of School
Child lives with:
Primary Parent/Guardian Name
Your answer
Driver's license (state and number)
Your answer
Address
Your answer
What is your zip code?
Your answer
Phone Number (home, work, & cell)
Your answer
Secondary Parent/Guardian Name
Your answer
Driver's license (state and number)
Your answer
Address
Your answer
Phone Number (home, work, & cell)
Your answer
Emergency Contact other than Primary and Secondary Parent/Guardian
Your answer
Emergency Contact (Relationship to child)
Your answer
Driver's license (state and number)
Your answer
Address
Your answer
Phone Number (home, work, & cell)
Your answer
Does anyone else have permission to pick up this child? (If so, who and list their phone number.)
Your answer
Does this child have any medical or health concerns? Is so, please describe.
Is your child capable of taking care of his/her own personal hygiene needs?
Does your child have any special needs of which the staff should be aware?
Does your child qualify for Special Education/504?
Has your child ever suffered from asthma or any related breathing disorder?
Does your child have allergies and/or allergic reactions to any foods, medications, or insect bites?
Does your child have an existing illness and/or a previous serious illness or injury, or hospitalization during the past 12 months?
I give permission for my child's work and/or photos of my child to be published in newspapers, magazines and/or any written or electronic publication, on the WISD and/or Community Ed website, blog, and social media such as Facebook, Instagram and Twitter.
It is understood by my child and me that all policies, regulations, and standards of the Weatherford Independent School District will be in effect and will be adhered to by my child.
I understand that ALL paperwork must be completed before my child may attend Kids Unite after school program. If there are any changes during the school year, it is my responsibility to inform the KU staff in writing.
I understand there is a $30 Registration Fee per family (not child) for the 2019-2020 school year. This can only be waived if I paid it during the summer. This will be added to my first week's payment.
I understand that I am responsible for paying every week my child is enrolled in KU. Payments are due on each Thursday before the following week. Kids Unite will accept cash, checks, money orders, Visa, Mastercard and Discover credit/debit. Cash, Debit or Credit cards will only be accepted at the Community Education office, located at 900 North Elm Street, Weatherford, Texas 76086 or call 817-598-2806 to pay by phone.
I am interested in the automatic on-line payment plan.
I am interested in the discounted rate.
Students MUST be picked up by 6:30 p.m. I understand a charge of $1.00 per minute is the late fee. (The campus clock will be the official timepiece.)
I release Weatherford ISD from liability in case of an accident. The staff has my permission to provide emergency health care if needed. I understand that I am financially responsible for any expenses for medical care and /or transportation incurred on my student' behalf. I have read and understand the about procedures and agree to comply with them.
My child will follow the rules for technology use while at Kids Unite.
My child has permission to use the school internet.
I have downloaded and read the Kids Unite Handbook with my child, including the policies, procedures and the discipline guidelines. We agree to abide by the standards, policies and procedures defined or referenced in this document.
Please have the Kids Unite Supervisor call me. I have questions or concerns. (Please include name and phone number if you want the supervisor to contact you, otherwise skip this question. )
Your answer
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