2019-2020 Kaleidoscope Application
Child's First Name: *
Your answer
Child's Last Name: *
Your answer
Child's Preferred Name:
Your answer
Child's Birthday:
MM
/
DD
/
YYYY
Child's Gender:
Parent First/Last Name: *
Your answer
Parent Cell: *
Your answer
Parent Email: *
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Emergency Contact (Name & Phone Number):
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Special Requests/Anything About Your Child You'd Like to Share:
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Please Select Class: *
Registration Options
Kaleidoscope - 9:45am-2:00pm
Includes: Spanish Introduction and Play-based Curriculum
*
Add Kid Spark Gymnastics Class (9:00-9:45am)?* *
*By choosing a Kid Spark Gymnastics option, I (the parent/guardian) am authorizing Kaleidoscope staff to pick up my child from Kid Spark and sign them into the Kaleidoscope Class. Please Initial below. *
Your answer
I have read and agree with Champions Westlake policies and authorize Champions Westlake to manually enroll my child in the Kaleidoscope Early Learning Program for the specified days and times in this application. I also understand that upon enrollment I will be charged the annual enrollment fee & supply fee of $175. The first month’s installment will be due August 15th. Please initial.
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