KCC Registration Form
Please share the information listed below. Thank you!
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Grade and Team *
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 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
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