Kingdom Kids Enrichment Programs
The Kingdom Kids Enrichment Programs strive to assist students reach their highest potential. We are dedicated to assist student with reading and math skills, engage them in STEM activities and provide them with a snack and a healthy meal.
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Email *
Untitled Title
The Please check which program in which you are enrolling a child(ren).
Please complete each question thoroughly.
Participant's Name *
Birthdate *
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Age *
T-shirt size *
Home Address: *
City, State
Zip Code
Parent/Legal Guardian: *
Parent/Legal Guardian's Contact Number *
Education
Please complete the information about the school your child attends.
Name of School *
Participant's Grade (if applying to summer camp, provide grade for fall). *
Please list any educational strengths/weaknesses.
Does your child have an IEP? (If so, please bring a copy with you.)
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Emergency Contact 1: Name *
Relationship to Student *
Emergency Contact 1: Cell Phone *
Emergency Contact 2: Name *
Relationship to Student: *
Emergency Contact 2: Cell Phone *
Emergency Contact 3: Name
Relationship to Student: *
Emergency Contact 3: Cell Phone
Important Information
To ensure the safety of your child please sign your name if you agree to the terms presented.
Medical Release:
If you would like for Kingdom Kids Enrichment Programs' staff to administer medication to your child, please provide a statement from the doctor as well as the prescription bottle with the dosage attached.
I hereby give permission to Kingdom Kids Enrichment Programs to follow instructions as listed on the Medical Release Form *
List any known allergies.
Release Statement:
I hereby affirm that my child is in good health and physically capable of performing required activities. In consideration of Kingdom Kids Enrichment Programs accepting my child, I do hereby release and forever discharge Kingdom Kids Enrichment Programs, its agents, and employees all claim of liability for any damages or injuries which may be sustained while my child is in their care. *
Photo Release
In the event that your child appear in a photograph, pamphlet or video by a staff member of Kingdom Kids Enrichment Programs.
I hereby give permission for my child’s picture to be used by Kingdom Kids Enrichment Programs' publications or video advertisements. *
Are there any other special needs that your child has?
Release of Minors:
All students will be released to their parent/guardian unless otherwise notified. A photo ID is required at the time of release.
All students are released at the end of the day to their parents/guardians or one of the individuals listed on the application unless otherwise directed by a court to do otherwise.
In addition to names already listed on this application, my child may be released to the following individual(s):
Please list the full names and cell phone numbers of anyone that you give permission to pick up your child.  Reminder: Photo Identification must be provided at pick-up time.
Name: *
Relationship to Student *
Cell Phone Number: *
Name: *
Relationship to Student *
Cell Phone Number: *
Parent Signature: *
Date: *
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A copy of your responses will be emailed to the address you provided.
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