Right Start Kids Academy Enrollment Form- Park City
We are very excited to welcome you and your child into the Right Start Kids Academy program! Please complete all questions below and note that some questions are asking your preference for days/times however we cannot guarantee each day/time. Rest assured we will do our best to accommodate all needs. If you have any questions about the form or program, please make a note and we will reach out to you. We will contact you within 3 days of your submission and will let you know final days by July 1. If you have questions concerning the Right Start Program email Kendall Heddens at kendall@blackdiamondgym.com
Sign in to Google to save your progress. Learn more
Email *
Parent First Name *
Parent Last Name *
Mailing Address (Street/City/State/Zip) *
Physical Address (if different than above)
Phone Numbers (Home/Cell/Work Please) *
Email Address *
Emergency Contact Name (other than parent) *
Emergency Contacts Relationship to Student *
Emergency Contact Phone Number (home/cell please) *
Student Name *
Sex *
DOB *
MM
/
DD
/
YYYY
Are immunizations current? *
Please describe any special needs your child may have:
Allergies (food, medication, insect bites, etc) *
Physician *
Physician Phone Number *
Please mark your preference for the days/times below. Again, we cannot guarantee that all options will be available. We will do our best to accommodate everyone. ***Please choose the class with the age that your child be be on September 1, 2021.
Terrific Two's 8:30am-11:30am *
Required
Preschool (ages 3-5) 8:30am-12:30pm *
Required
Discovery Day- Friday Only (ages 4-5) 8:30am-12:30pm Children will have a gym class and enjoy a morning full of fun! New themes each week make the experience a perfect match for your child's curiosity and desire to learn. *
Required
Please check the boxes to agree to the following:
If my child(ren) require emergency medical attention, I give permission to the staff of Right Start Kids Academy and Black Diamond Gymnastics & Sports Centers, to see or administer the necessary medical care. I understand that they will make every effort to contact me and/or the emergency contact(s) listed above. *
I give my permission for Right Start Kids Academy and Black Diamond Gymnastics & Sports Centers to transport my child(ren) by automobile if they are registered for camps with field trips, kindergarten enrichment or our Kids Klub programs. I understand that providing a booster and car seats for use is my responsibility. *
If, in Right Start Kids Academy and Black Diamond Gymnastics & Sports Centers judgement, your child is enrolled in a program not appropriate to his or her age/ability level, Black Diamond and/or The Academy RESERVE THE RIGHT TO MOVE YOUR CHILD to the appropriate program when space is available. *
Right Start Kids Academy requires a deposit/registration fee of $199.00. The card stored to your file will be charged to hold your spot. *
Withdrawals from the program MUST BE SUBMITTED IN WRITING to the front desk 4 WEEKS prior to the actual drop date. Verbal drop notices to teachers or via phone will not be accepted. *
All deposits are non-refundable and must be included with all completed paperwork in order to guarantee school reservation. Any changes to initial reservation must be submitted in writing and will be honored if space permits. **Arrangements for additional class sessions for after school enrichment students may be available and must be discussed with Academy director. If you do not have not been registered in classes with Black Diamond previously, you will need to click on the link below to create a Jackrabbit Account so you can be billed the registration fee and monthly billing fees. This must be done within 24 hours of submitting this form. By clicking here in understand that my card on file will be charged to hold my Childs spot. *
For Jackrabbit billing/registration, please click on the link below. You will not be able to 'Register' for Right Start via the link, you will only register your information and your child's information. Thank you
Notes
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy