Winter/Spring 2021 IN-PERSON Programming Questionnaire
Dear Parent,

Please fill out this questionnaire to flag your interest in joining our programming. This is not a registration form. We will reach out with registration details and onboarding steps after we are able to place your child.

You AND your caregiver(s) should read our health and safety information in detail before submitting your interest. https://www.kidsatworknyc.com/policies-health-safety/

Please note we are currently enrolling children over 12 mos only. To be placed on our waiting list for infants, please email info@kidsatworknyc.com.
Email address *
Parent FULL Name: *
Parent Phone Number: *
Parent Mailing Address: *
Child 1 FULL Name: *
Child 1 DOB: *
MM
/
DD
/
YYYY
Child 2 Full Name
Child 2 DOB
MM
/
DD
/
YYYY
Regarding siblings, would you like for them to be placed in the same group? Please note unregistered siblings are usually not able to be accommodated due to capacity issues.
Clear selection
Regarding siblings, if you'd like for them to be placed in separate groups, please note any caregiver concerns or time constraints. For instance, if your younger child can only come while older child is in school, or if you have 2 caregivers so logistics aren't a problem, etc.
Please list any allergies your child(ren) may have: *
Please list any and all underlying health conditions your child(ren) may have: *
Please provide the following information for any adults that will accompany your child to class.
Your family should plan to send the SAME adult to classes each week, with very few exceptions. A maximum of one adult per child may attend class at a time. You MUST supply Kids at Work with either a direct email or phone number for your caregiver. Kids at Work only contacts caregivers in the situation that there is a positive case and they may be a close contact. Kids at Work will also give this information to NYC Test and Trace in case of a positive case where the caregiver is a close contact. If we contact your caregiver, we will notify you as such. It is very helpful to give alternate parent contacts here, also in the case of a positive case and we need to get in touch rather urgently.
Adult 1 Name *
Adult 1 Email Address *
Adult 1 Phone Number *
Adult 2 Name (if applicable)
Adult 2 Email Address (if applicable)
Adult 2 Phone Number (if applicable)
Adult 3 Name (if applicable)
Adult 3 Email Address (if applicable)
Adult 3 Phone Number (if applicable)
I need to add more adults, so please contact me.
Clear selection
Please indicate any of the following classes you would be interested in attending. For a description of the classes please visit our website here: https://www.kidsatworknyc.com/mommy-and-me-fall-2020/
Please indicate if you would be interested in attending either of the Gentle Separation Programs. For a description of the classes please visit our website here: https://www.kidsatworknyc.com/playgroup-gentle-separation/
What if none of the above classes work for your child? If none of the above classes work for you please indicate below which days, times, and programs work for you. We will be forming new cohorts, including those on the weekend. Note all students must fill out a separate questionnaire.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
9am - 10am
10am - 11am
11am - 12pm
12pm - 1pm
1pm - 2pm
2pm - 3pm
3pm - 4pm
4pm - 5pm
5pm - 6pm
What if none of the above classes work for your child? If none of the above classes work for you please indicate below which class you are interested in. We will be forming new cohorts, including those on the weekend. For a description of the classes please visit our website here: https://www.kidsatworknyc.com/mommy-and-me-fall-2020/
Are there any days of the week when you CANNOT attend class or any specific schedule limitations besides noted above? Please note space is extremely limited due to small groups, so listing more times increases your chances of being placed.
Would you like to be in class with a particular child or group of children? Please note that preference here.
Pricing will be $75 per child, per class for all groups, due to our capacity being reduced to only 25%. Does this pricing structure fit with your budget? Tuition assistance is available. *
Required
Thank you for taking the time to participate in this questionnaire. Kids at Work will reach out to you with information on which group you've been placed in, as well as next steps!
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