Kingdom Kids Summer Enrichment Program
The Kingdom Kids Summer Enrichment Program strives to assist students reach their highest potential. We are dedicated to assist student with reading and math skills, engage them in STEM activities and provide them with a snack and a meal.
Email address *
Please complete each question thoroughly.
Participant's Name *
Participant 2 Name
Participant 3 Name
Name of Parent/Guardian: *
Address: *
Cell Phone: *
Education
Please complete the information about the school your child attends.
Name of School *
Participant's Grade *
Please list any educational concerns.
Emergency Contact 1: Name
Relationship to Student
Emergency Contact 1: Cell Phone
Emergency Contact 2: Name
Relationship to Student: *
Emergency Contact 2: Cell Phone *
Emergency Contact 3: Name
Relationship to Student
Emergency Contact 3: Cell Phone
Important Information
To ensure the safety of your child please sign your name if you agree to the terms presented.
Medical Release:
If you would like for Kingdom Kids Afterschool Care Enrichment staff to administer medication to your child, please provide a statement from the doctor as well as the prescription bottle with the dosage attached.
I hereby give permission to Kingdom Kids Summer Enrichment to follow instructions as listed on the Medical Release Form *
Release Statement:
I hereby affirm that my child is in good health and physically capable of performing required activities. In consideration of Kingdom Kids Summer Enrichment accepting my child, I do hereby release and forever discharge Kingdom Kids Summer Enrichment, its agents, and employees all claim of liability for any damages or injuries which may be sustained while my child is in their care. *
Photo Release
In the event that your child appear in a photograph, pamplet or video by a staff member of Kingdom Kids Afterschool Care Enrichment.
I hereby give permission for my child’s picture to be used by Kingdom Kids Summer Enrichment publications or video. *
Travel:
Kingdom Kids Summer Enrichment may on occasions participate in a field trip (i.e. Library, McWane Science Center, Alabama Theater...)
I give permission for my child to travel to field trip destinations which relate to topics being studied. I understand that I will be informed prior to every field trip.
Clear selection
How did you hear about us?
Note: By signing below, you acknowledge that you have read and agree with each item.
Parent's signature
Release of Minors:
All students will be released to their parent/guardian unless otherwise notified. A photo ID is required at the time of release.
All students are released at the end of the day to their parents/guardians or one of the individuals listed on the application unless otherwise directed by a court to do otherwise.
In addition to names already listed on this application, my child may be released to the following individual(s):
Please list the full names and cell phone numbers of anyone that you give permission to pick up your child. Reminder: Photo Identification must be provided at pick-up time.
Name: *
Cell Phone Number: *
Name: *
Cell Phone Number: *
Parent Signature: *
Date: *
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