KAC After School Program Registration
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Email *
Participant Name(s) *
Participant(s) Age, DOB, Grade (must be in the 4th-8th grade, ages 8-13) *
Participant Address *
Emergency Contact Info (Name, Ph#) *
Are you: *
Please list authorized pickup contact info (Name/Ph#/Relationship to Participant), if different than parent/guardian: *
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