KidSpace Registration Form 2024
KidSpace is a summer, school-age child care for students who are ENTERING kindergarten through 5th grade.  KidSpace will be held from Wednesday, June 5th - Friday, August 23rd from 7:00am to 5:30pm. Part Time children must pick two or more SET days at $35 a day. Full time children may attend any hours for $150 a week. There is a registration fee of $25 at the time of registration PER CHILD. This also includes a KidSpace T-shirt - which is to be worn on field trips. Registration is accepted throughout the summer as space allows, but is required before the week of attendance. EACH CHILD SHOULD HAVE THEIR OWN REGISTRATION FORM! 
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Email *
Child's Full Name *
Child's Birthday:  *
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My child has completed: *
My child attends *
My child's shirt size is (registration must be completed by May 15th to get a shirt)  *
Address *
Child will attend KidSpace: *
If you answered part time, how many days a week will your child attend? They must be the same days each week for staffing purposes.
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If your child is attending part time, check each day of the week that your child will attend
Around what time do you think you will be dropping off your child(ren) in the morning?  *
Around what time do you think you will be picking your child(ren) up in the afternoon?  *
How will you be making payments each week? *
Who is NOT allowed to pick your child up from KidSpace
Allergies/Health Conditions/Allergies to Meds: 
Current Medications Taken
Family Doctor/Clinic Name *
Family Dentist/Office Name *
Father's Name *
Father's Phone Number *
Father's Address *
Father's Place of Employment & Work Phone Number *
Mother's Name  *
Mother's Phone Number *
Mother's Address *
Mother's Place of Employment & Work Phone Number *
TWO Emergency Contact's Information (please include Name, Phone Number, and Relationship to Child)  *
In case of accident or sudden illness, the staff of KidSpace has my permission to obtain medical assistance or ambulance service if it is determined necessary (By marking yes or no this is your signature)   *
My child has permission to participate in off-site field trips with KidSpace Staff  *
My child has permission to watch/attend MOVIES with a PG rating while attending KidSpace *
KidSpace has my permission to use my child's photo for newspaper/web posting *
KidSpace has my permission to apply sunscreen to my child
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KidSpace has my permission to apply bug spray to my child
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I, Parent/Guardian, have read the KidSpace Handbook and understand ALL the policies and procedures. 
Type your name in for "signature". 
 *
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