City Kids Registration Survey
Fall 2019 - Spring 2020
Email address *
Name of parent/guardian #1 *
Your answer
Full address of parent/guardian #1 *
Your answer
Phone of parent/guardian #1 *
Your answer
Name of parent/guardian #2 (or N/A) *
Your answer
Full address of parent/guardian #2 (if different)
Your answer
Email of parent/guardian #2 (or N/A) *
Your answer
Phone of parent/guardian #2 (or N/A) *
Your answer
Name of child you are interested in registering for City Kids. *
Your answer
Your child's date of birth. Please note, for 2019 - 2020, classes will be appropriate for children ages 9-13. Children a little older or younger may be considered on an individual basis. *
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Gender (Please note, we welcome children of all gender identities. You can be as specific or non-specific as you choose.) *
Your answer
Name of second child you are interested in registering for City Kids (or N/A). *
Your answer
Date of birth of second child (if N/A, enter date of survey completion). *
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Gender of second child (or N/A). *
Your answer
Name of third child you are interested in registering for City Kids (or N/A). *
Your answer
Date of birth of third child (if N/A, enter date of survey completion). *
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Gender of third child (or N/A). *
Your answer
Please list the ages of all other siblings in the family you are NOT seeking to register for City Kids (or N/A). *
Your answer
Which parts of our program are you interested in? Please consult our program page before answering. (Please note, our programs can change from year to year. These are the programs we offered in 2018 - 2019.) *
Required
Check the days you would like to attend. Please consult our FAQs page for our current schedule. (Please note, it is possible that our schedule can change from year to year.) *
Required
From September to May, each family will be required to lead activities and plan trips. Are you comfortable making this commitment? *
City Kids' health policy states that kids who are sick with a runny nose, cold, rash, fever, cough, sore throat, or any other sign of illness stay home until they are cleared of symptoms. Are you comfortable with this policy? *
City Kids is an inclusive community. We welcome members of all cultural backgrounds, belief systems, gender identities, sexualities, and political persuasions. How do you feel about this policy? *
City Kids promotes anti-racist and anti-bias values in its curriculum. How do you feel about this policy? *
City Kids' curriculum is inclusive of all genders and sexualities. This policy means that we may include materials and discussions that are supportive of the LGBTQI community and their rights. For example, we may read literature with characters who happen to be LGBTQI. How do you feel about this policy? *
Our curriculum is secular and science-evidence based. We have families with diverse beliefs, from atheist to religious, and while we may learn about different beliefs in our World Culture's program, our curriculum is non-faith based. Parents are expected to teach/participate with this understanding. How do you feel about this policy? *
Does your child have any social/behavioral challenges? If yes, please provide details here. *
Your answer
Does your child have any academic challenges that might impact their participation? *
Your answer
Have you ever participated in collaborative education before? If yes, please describe your experience. *
Your answer
City Kids does not offer drop off. How do you feel about this policy? *
City Kids' policy states that younger siblings are not allowed in the lesson areas and for most activities. How do you feel about this policy? *
Because City Kids does not allow younger siblings to be present during lessons and most activities, and parents are required to be present, parents with younger children would need to arrange for child care for their younger children or for an alternative caregiver for their older children while they are at City Kids' activities. How do you feel about this policy? *
Why are you filling out our survey? *
Please include any additional information about your child and your family that you feel is an indication that your family would be a good fit for City Kids. *
Your answer
Before submitting your survey, all prospective families are required to read our "FAQs about City Kids" page. Please acknowledge here that you have read the page thoroughly. *
Required
Before submitting your survey, all prospective families are required to read through the different programs on "Our Programs" page. Please acknowledge here that you have read those pages thoroughly. *
Required
Families who may be a good fit will be notified and sent an invoice for the $20 survey fee to the e-mail address provided on this survey. Payment of this fee does not guarantee acceptance. Once registrants pay the fee, they will be contacted to set up a trial day and/or an interview (either in person or on the phone). This fee is non-refundable, even if the family does not show up for interviews and/or trial days, the family decides not to join, or if City Kids makes the decision that the family is not a good fit after an interview and/or a trial day. If the family is not able to attend interviews and/or trial days, City Kids is not responsible for refunding the fee. families who will not be asked to have an interview and/or a trial day will be notified that they are not a good fit at this time, and they will NOT be sent an invoice. *
Required
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