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Discovery Kidzone Elementary School and Before/After School Registration Form
Before and Afterschool Care Registration
Expected Start Date
MonthDayYear
School Attending
Grade Attending
Pick When
Which class are you wanting to register for?
What days of the week are you looking for care?
Student Information
First Name
Last Name
Gender
Birth Date
MonthDayYear
Home Phone
Area CodePhone Number
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Insurance Group #
Doctors Name
First NameLast Name
Doctors Phone Number
Area CodePhone Number
Parent/Guardian Information 1
Full Name
First NameLast Name
Home
Area CodePhone Number
Cell
Area CodePhone Number
Work
Area CodePhone Number
E-mail
Address - Same As Child
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Parent/Guardian 1 Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Parent/Guardian Information 2
Full Name
First NameLast Name
Home
Area CodePhone Number
Cell
Area CodePhone Number
Work
Area CodePhone Number
E-mail
Address - Same As Childs
If your address is different than the childs please fill out the info below. Otherwise move onto the next section.
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Other Infomation
Would your child like to be in a class with a friend?
If yes, name and age of friend(s)?
Is your child immunized?
Does your child have any allergies?
If yes please list, including any food or drug allergies.
Does your child have any medical conditions?
Does your child require any medication? If yes, please list these medications.
Do you authorize us to administer the medications listed above?
Please list the people authorized to pick up your child.
Does your child have any siblings?
If yes, what is their age(s)?
Comments
Are you a member of Best Beginnings subsidy or Childcare Aware?
If yes, which one?
Emergency Contact - Other than Parent/Guardian
Full Name
First NameLast Name
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list. There is a 26 dollar wait list fee. If your child has a spot, you will pay the registration fee and fill out the remainder of the enrollment forms.
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Home
Area CodePhone Number
Cell
Area CodePhone Number
Work
Area CodePhone Number
Signature
Should be Empty:

Discovery Kidzone Elementary School and Before/After School Registration Form

Before and Afterschool Care Registration

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Other Infomation

Emergency Contact - Other than Parent/Guardian