Authorized Pick-Up People (other than guardians listed above)(Kinetic Bridges requires notification in writing when someone other than a parent/guardian pick up a student. In case of emergency, Kinetic Bridges will accept a phone call and release your child to the person(s) indicated below. We check Drivers' Licenses to verify identity.)Name: First Name Last Name* Name: First Name Last Name Name: First Name Last Name Name: First Name Last Name
Immunizations and Medical Information
I agree to provide proof of my child’s immunizations proof/waiver within 10 business days of signing the enrollment agreement. Proof of Immunization/waiver of immunization may be provided via email to email@example.com or mailed to :
Kinetic Bridges c/o The Springs Church
5500 S Southwood
Springfield, MO 65804
Medical Information, Contacts, and ReleaseStudent Name: First Name Last Name Student Birthday: Date Parent(s): First Name Last Name and First Name Last Name Address: Street Address Address Line 2 City State Zip Best Parent Contact Name: First Name Last Name Phone:Area Code Phone Number 2nd Best Parent Contact Name: First Name Last Name Phone: Area Code Phone Number Emergency Contacts (besides parents):Name: First Name Last Name Auth. Pickup:
Type Option 1
Type Option 2
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Phone: Area Code Phone Number Name: First Name Last Name Auth. Pickup:
Type Option 1
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Phone: Area Code Phone Number Medical InformationAllergies/Medical Conditions & Medical Needs: My child has allergies (food, environmental, seasonal). PLEASE list below. My child does NOT have allergies of any kind. allergies/medical allergies/medical allergies/medical allergies/medical allergies/medical allergies/medical allergies/medical allergies/medical Medications: (indicate which need to be administered during school)Name: Name Dosage: dosage Route: type School: Name: Name Dosage: dosage Route: type School: Name: Name Dosage: dosage Route: type School: Name: Name Dosage: dosage Route: type School: Over-the-Counter Medications to be administered as needed: Indicate which medicine your child may have by checking the medicine. (If your child requests/needs medicine not approved, we will contact you first.) Tylenol Tums Benadryl Ointment Advil Cough Drop Anti-Itch Cream Sunscreen Doctor & Hospital InformationMedical Doctorname Phone: Area Code Phone Number Address: Street Address Address Line 2 City State Zip Hospital Name: Dentist Name: Name Phone: Area Code Phone Number Address: Street Address Address Line 2 City State Zip Insurance Company: Name Phone: Area Code Phone Number Policy Number: policy Group Number: group Customer Service Phone Number: phone In the event of an emergency, Kinetic Bridges will make every reasonable effort to contact parents/emergency contacts as soon as possible.Permission to Treat( initials Parent Initials) I hereby give permission for my child to be given emergency treatment, including first aid and CPR by a qualified staff member of Kinetic Bridges. I further authorize and consent to medical, surgical, and hospital care, treatment, and procedures to be performed for my child by my child’s regular physician or hospital when deemed immediately necessary or advisable by the physician to safeguard my child’s health if I cannot be contacted. In such a case, I waive my right of informed consent to such treatment.( initials Parent Initials) I give permission for my child to be transported by ambulance or aid car to an emergency center for treatment. I further authorize Kinetic Bridges to take my child to a hospital, and I agree that I will pay all physician and hospital bills, and Kinetic Bridges shall not be responsible for them. ** Please see Assumption of Risk and Liability Waiver for full liability release.**
Assumption of Risk Liability Waiver & Release
On behalf of my minor child, I hereby give permission for my child to participate in Kinetic Bridges School or programs. I hereby warrant that both myself and my child are familiar with the risks associated with participation in Kinetic Bridges School or activities. I acknowledge that my child’s participation in this program is wholly voluntary.I do hereby agree and consent to my child’s participation in Kinetic Bridges School or programs during this school year and do assume all risks and hazards which are conducted as part of the associated activities. I hereby release, absolve, indemnify, and hold blameless Kinetic Bridges, its officers, directors, employees, contracted employees, independent contractors, instructors, agents, organizers, and volunteers of any and all liability for damage, injury, or expense of any kind arising out of or connected with my child’s participation in Kinetic Bridges School or programs. I understand that in case of a medical emergency, my own personal medical plan will be used if available; if not, medical aid may be sought while I am being contacted. In the event of any illness or injury, I hereby consent to whatever examination, diagnosis, or treatment and the hospital care from a licensed dentist, physician, and/or surgeon as deemed necessary for my child’s safety and welfare. I understand that the resulting expenses will be my responsibility and not the Kinetic Bridges School or programs, or any affiliates. As a condition of participation in the Kinetic Bridges School or programs by the student named in this application, I acknowledge that I have read this consent form, and knowingly, on behalf of my child, assume all of the risks associated with participating in any way in Kinetic Bridges or its programming. As consideration for being permitted to participate in the program, I hereby agree that I, my assignees, heirs, distributees, guardians, and legal representatives will not make claim against, sue, or attach the property of the Kinetic Bridges school, program(s), or their Affiliates or the supplier of any of the equipment used in these activities for injury or damage resulting from negligence, failure of care, omission or other acts, howsoever caused by an employee, agent or contractor of Kinetic Bridges School, programs and any affiliate as a result of incidental to my child participation in these activities. I hereby release, to the fullest extent permitted by law, Kinetic Bridges School, programs and the affiliates, from any and all actions, claims, demands, or liabilities that I, my assignees, heirs, distributes, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my son/daughter’s participation in these activities irrespective of whether the same is based on breach of warranty, negligence, strict liability or any other theory or recovery. I have read this agreement and agree to the conditions stated above.
Field Trip Release
PARENT/GUARDIAN PERMISSION AND RELEASE OF LIABILITY FOR FIELD TRIP I understand that although the students will be supervised by (Kinetic Bridges faculty and staff), I do assume the risk in my student’s participation in the event. I acknowledge that I will not seek to have Kinetic Bridges or KB Academy held liable in the event that any accident, injury, loss of property, or any other circumstance or incident occurs during or as a result of my son’s/daughter’s participation in the field trip. This release of liability includes accident, injury, loss, or damages to the student, as well as, to other individuals or property which may result from the student’s participation in the event. I hereby release and agree to hold harmless Kinetic Bridges, its officials, agents, and employees, from any claims arising out of my son’s/daughter’s participation in the event(s). I have read and understood and accept all of the statements recited above and accept full responsibility as described.
** Transportation is not provided for field trips so parents will need to transport students to and from field trips. Field Trips are considered enrichment and are encouraged, but not required.
Photography & Video Recording Release
Throughout the school year, there may be times when Kinetic Bridges staff or other organizations may take photographs of students, audio/videotape students, or interview students for school-related stories in a way that would individually identify a specific student. Those images and recordings may appear in publications, Kinetic Bridges Website, Kinetic Bridges Facebook Page, in the news media, or in other organizations-related stories or articles.
Do you attend church regularly? please type yes or no here* If so, where do you attend? name of church.
Statement of Faith and Beliefs
Kinetic Bridges believes and unapologetically teaches that every person is a unique creation; loved by God. Therefore, we treat all people with respect, honor, compassion kindness, dignity, and love as modeled by Jesus Christ. At Kinetic Bridges, we believe in modeling and representing Jesus to the world. Therefore, hateful, harassing behaviors or attitudes directed toward any person or group, for any reason, are not in accordance with Scripture, nor the beliefs of Kinetic Bridges.
We desire to provide a Biblical model for students, families, and our community. To provide this model, we uphold the following statements of belief. All administration, teachers, and staff must fully subscribe to the following statements of belief. Although parents may not fully agree with each element of this statement, all teachers will unapologetically teach consistently with these beliefs, and man not teach in a way that contradicts these beliefs and may not teach in a way that contradicts these beliefs. At times, it may be necessary to discuss secular concepts at age-appropriate levels for students so they may learn how to defend their faith in a secular world.
These statements do not fully exhaust the extent of our beliefs. The Bible itself, as the inspired and infallible Word of God, is the sole and final source of all that we believe. For the purposes of K.B. Academy's function, practices, policies, and disciplines, the Board of Directors is considered the final interpretive authority. Staff are responsible for declaring differences with the Statement of Faith before terms of employment are finalized. Declarations of differences will be evaluated by the Board of Directors before employment is finalized.
K-6th Grade Statement of Compliance (Parent/Guardian): I understand my child must abide by the Kinetic Bridges Student/Parent Handbook and Statement of Faith and Beliefs in their entirety and have gone over these expectations with my child.
7th - 12th Grade Statement of Compliance (Student): I blank (student) agree to abide by the Kinetic Bridges student/Parent Handbook and Statement of Faith and Beliefs in their entirety.
Tuition Payment Agreement
Parent(s) will pay tuition to Kinetic Bridges according to one of the following payment schedules. Please indicate the program you are applying for:
Konnect in Kare (K.I.K.) Program
Each family at KB Academy is an integral part of their child's educational journey. We desire for parents to collaborate with us as a school to provide the highest level of education possible. The K.I.K. Program allows families to support their child's educational process and KB Academy. Each family is required to provide K.I.K. hours. Single-parent households provide 12 K.I.K. hours a year, while dual-parent households provide 24 K.I.K. hours a year.
K.I.K. hours can be obtained in multiple ways. Some of the most common are: Lunch Monitor, Science assistant, Teacher helper, Parent Life Organizer, Purchasing supplies from the KB Wish List ($10 of supplies = 1 K.I.K. hour). A detailed list of ways you can support your child and KB Academy will be provided to families upon enrollment.
By signing below, you are acknowledging, and agreeing to actively participate in the K.I.K. program.
** If you work full-time, and are unable to assist during the school day, we can provide you with the KB Wish List link so you can get your K.I.K. hours.
K-Day Fridays at KB Academy
Friday at KB Academy is a fun-filled half-day where we learn in a different format from Monday and Wednesday. We utilize rotations to provide access to more hands-on learning, games, growth opportunities, and elective-style classes for both Elementary and Secondary students.
To make Friday's a success, parents/guardians are required to sign up and help on a rotational basis. Opportunities to assist during K-days abound; from lunch monitor, art leader, survival skills teacher, classroom assistant, clean up monitor to teaching or leading a specific Friday rotation. Our K-Day Coordinator will work with parents to schedule you in roles you feel comfortable filling and will provide the support, plans, and assistance as needed.
By signing below, you are acknowledging, and agreeing to sign up, participate and serve during Friday K-Days.
* Full-time working parents will be provided with an alternate way to contribute to Friday K-Days.
Enrollment Cancellation Policy
Parent(s) may cancel enrollment by providing written notice of cancellation to Kinetic Bridges no later than August 1st. If Parent(s) cancels enrollment or if the student withdraws from the school, after August 1st, parent(s) are required to provide at least 30 days of written notice and attend a face-to-face meeting.
Parents will remain obligated to pay the remaining tuition for the quarter if proper notice is provided. In the event, proper notice (as described above) is not provided, parents will remain obligated to pay full tuition for the remaining academic year (August through May) even if the child no longer attends a Kinetic Bridges program. All fees that occurred prior to the withdrawal date are still due and payable and are subject to collections.
Failure to make timely tuition payments may result in suspension or dismissal of the student from Kinetic Bridges programming, the incurrence of late fees, and other consequences.
Parent/Student Regulations and Code of Conduct
We understand that admission to Kinetic Bridges is a privilege, not a right and that any behavior, either on or off-campus, which is not consistent with Kinetic Bridges' standards as stated in the Student/Parent Handbook, Statement of Faith and Beliefs could result in the loss of that privilege to be determined by the Administration and/or Board of Directors at any time during the year. I understand admission is for a term of one school year and does not guarantee automatic admission for future school years. We have read and agree to abide by the Kinetic Bridges Statement of Faith and Beliefs and the current Student/Parent Handbook in their entirety. We understand our actions and the actions of our child/child(ren) enrolled in Kinetic Bridges programs must be in compliance with these statements. We recognize that Kinetic Bridges reserves the right to dismiss any student (without a tuition reduction or remission) in the event he/she or members of his/her immediate family engage in conduct that Kinetic Bridges considers to be detrimental to the learning environment or reputation of Kinetic Bridges, that fails to support policies or regulations, or that prevents the Kinetic Bridges from fulfilling its mission. Dismissal may occur at any point in the school year. We understand that the basis for dismissal can include, but is not limited to, a violation of the current Student/Parent Handbook, failure to maintain acceptable academic standards as outlined in school policy, or a single on or off-campus act.
We agree to be bound by the conditions of enrollment expressed in this Contract and to support Kinetic Bridges in the administration of the policies and in the enforcement of all regulations.
This contract shall be governed by the laws of the State of Missouri. The undersigned agrees to pay reasonable costs for the collection of past due accounts, including professional fees. We understand that each provision of this Contract is severable and independent, and will remain in full force and effect, without regard to the ability to enforce any other provision(s). In signing this Contract on or behalf and on the behalf of all others having a parental and/or guardian relationship to the student, we agree to all the terms of the Contract.
1.) Tour our Facility and have a Family Interview
2.) Complete this application and pay the application fee
3.) Complete the Student Interview
5.) Complete the enrollment contract and pay the enrollment fee
6.) Pay the Curriculum fee (an Invoice will be emailed)
* All 6 steps must be completed to hold your child's spot.
2.) Complete this application and pay the application fee
4.) Complete the enrollment contract and pay the enrollment fee
* All 4 steps must be completed to hold your child's spot.
Acknowledgment of Nondiscrimination
Kinetic Bridges does not discriminate against students or families with respect to race, creed, ancestry, marital status, gender, sexual orientation, age, physical disability, political service or affiliation, color, religion, or national origin.
Kinetic Bridges is unapologetically a Christian-based organization and our officers, directors, committee members, employees, and volunteers may fully proclaim the Gospel as written in the Holy Bible. We believe all humans are created equal and all are worthy of love, honor, and respect.