Kids Plus Registration
Session One November-December 2017
Email address *
Childs Name and Last Name *
Example: Jane Doe
Your answer
Guardian Name and Last Name *
Example: Jane Doe
Your answer
Special Needs *
Your answer
Class Room Teacher *
Example: Mrs. Doe
Your answer
Guardian Cell Number *
Your answer
Guardian Work Number *
Your answer
Emergency Name and Number *
Example: Jane Doe 218-000-000
Your answer
E-mail address *
Your answer
Tuesday First Choice *
Tuesday Second Choice *
Wednesday First Choice *
Wednesday Second Choice *
Thursday First Choice *
Thursday Second Choice *
I give permission for my child to participate in the Moose Lake Schools KIDS PLUS After-School Enrichment Program. I allow them to leave school property as part of an ASE Class and understand photos or video of them may be used for program outreach.
Questions or Comments
Your answer
A copy of your responses will be emailed to the address you provided.
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