KCC Registration Form
Please share the information listed below. Thank you!
Email address
Child's Last Name
Your answer
Child's First Name
Your answer
Mother's Name
Your answer
Mother's Work Phone
Your answer
Mother's Cell Phone Number
Your answer
Mother's Email Address
Your answer
Father's Name
Your answer
Father's Work Phone Number
Your answer
Father's Work Phone
Your answer
Father's Cell Phone
Your answer
Father's Email Address
Your answer
Other Emergency Names and Phone Numbers (we might need)
Your answer
Please sign my child up for the following sessions:
Required
Payment Options
Required
I understand that I need to have a set schedule for my child or need to respond to the weekly KCC email about my child's attendance. (Please initial.)
Your answer
Please list any health concerns. The nurse's office is not open during KCC hours.
Your answer
The following people are authorized to pick up my child. (Please list names and phone numbers.)
Your answer
My child has my permission to walk home.
Parent/Guardian Signature (please type)
Your answer
Date
MM
/
DD
/
YYYY
Please complete the captcha before submitting the form.
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