KAVI YO! After School Program Registration Form
Start Date: October 9, 2017
Location: 451 Clarkson Ave, Brooklyn, NY 11203
Contact us at 347.977.5268
Email address
Student First Name
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Student Last Name
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Student Date of Birth
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DD
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YYYY
Student Street Address
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City
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State
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Zip Code
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Current School
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Parent First Name
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Parent Last Name
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Parent Phone Number (Primary)
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Parent Phone Number (Work, Secondary)
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Emergency Contact
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Emergency Contact
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I hereby consent to my child attending KAVI Young Ones After School Program on the agreed dates. I also grant permission for my child to participate in off property trips when included as part of their described program using such means of transportation as deemed necessary by KAVI YO. I understand that this program may include active games, outdoor pursuits, and/or aquatic activities, as well as activities specific to chosen programs.
Required
KAVI Young Ones After School Program requires special consideration regarding student behavior and attitude. I understand that my child must follow the direction of the leaders and adhere to the program policies regarding appropriate social behavior. The illegal use of drugs or alcohol is grounds for immediate dismissal. Smoking is not permitted. Any behavior that puts the safety of others at risk cannot be tolerated. If in the opinion of the program staff, my child demonstrated persistent inappropriate behavior, (s)he will be withdrawn from the program and I will be responsible for arranging to have him/her picked up from camp immediately. There will be no refund of any kind offered in this instance.
I hereby consent to the taking of photographs, movies or video tapes of my child by KAVI YO After School Program or its designated representatives, in connection with fundraising material, promotional brochures or videos. I also grant the right to edit, use and reuse said products for any and all educational, public service or not-for-profit purposes selected by KAVI YO and release any and all rights, title and interest we or my child may have in said photographs, movies/videotapes, finished pictures, reproductions, copies or negatives of the same in connection with such uses. (Photocopies and facsimiles of this release and consent shall have the same legal effects as the original.)
I, the undersigned parent/guardian, release KAVI YO After School Program and associated programs from all obligations in the event of an accident for which they are not negligent.
Required
I hereby give permission for the transportation of my child for official KAVI Young Ones After School Program activities by modes of transportation agreed to by the camp organizers.
Dietary restrictions
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