WKC Distance Program Registration 20-21
This form will be used as your student's registration for the distance program offered at Willits Kids Club
Email address *
Student Name- First and Last If you have more than one student attending, please fill out separate forms for each student. *
Grade Level *
Guardian Name First and Last *
Contact Numbers *
Are interested in receiving craft and activity materials through WKC? (They will be delivered.) *
Are you interested in your student receiving virtual academic and enrichment support? *
Does your child need academic help? *
How has school been going for your student? How can we support your student during distant learning? What challenges have you been facing? *
Are there any program suggestions or other needs that you would like to make us aware of? *
Type your Initials as a signature for this form *
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