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Enrollment Form
Kind In The Making
2023-03-14T20:38:20+00:00
Kind in the Making Enrollment Form
This form will take about 20 minutes to complete.
2023 - 2024 After School Enrollment FULL FORM
Contact Information
Parent Name
Parent Email Address
Parent Cell Phone
Parent Work Phone
Your Child's Information
Child's Name
Child's DOB
Child's Age
At this time, we offer Monday - Friday after school care. Tuition remains the same regardless of how many days your child attends. Is there a specific day(s) your child will not attend?
Teacher's Name & Room Number
Additional Parent Name
Additional Parent Email Address
Additional Parent Cell Phone
Additional Parent Work Phone
Emergency Contact Name & Phone Number
Emergency Contact's Relationship To Child
Does this emergency contact have permission to pick up your child in case of an emergency?
Additional Emergency Contact Name & Phone Number
Additional Emergency Contact's Relationship to child?
Does this additional emergency contact have permission to pick up your child in case of an emergency?
Child's Physician & Phone Number
Any specialists your child visits:
Known allergies, intolerances, or health conditions that your child has or has had in the past:
Any regular medications that your child takes:
Do you have any concerns regarding your child’s: (Please check all that apply)
Behavior
Motor Development
Social/Emotional Development
Cognitive Development
Hearing
Vision
Eating Habits
Sleep Habits
Other
Please elaborate on any boxes checked above
Has your child been exposed to any form of trauma? (Surgery, prolonged absence of a caregiver, death of a family member, drug/alcohol abuse by someone close to them, sexual abuse, domestic violence, etc.) that we should be aware of in order to serve them better?
Does your child have an IEP or is there an IEP being developed for them at their school? *If yes, please email a copy of your child's IEP after submitting this form.
Yes
No
Is there anything else that we should know about your child’s current or past health & medical history?
Were there any problems or concerns with your child’s former childcare/camp programs?
How would you describe your child? (Personality traits)
What are some activities that your child currently enjoys most?
What are some activities that your child is reluctant to engage in?
Are there any activities that you would like to see your child do more of?
Foods your child enjoys most & least?
What language(s) are spoken most in your home?
How does your child express anger/frustration?
Does your child have any particular fears?
When your child is upset, what often works to comfort them?
Which methods, techniques or phrases do you use to discipline your child?
Are there any common disciplinary problems at home?
Does your child join in play with other children?
Yes
No
On Occasion
Is your child able to reach a conflict resolution with a peer?
Yes
No
On Occasion
With adult assistance
Thank you for taking the time to fill out this enrollment form! We take caring for your child very seriously and we are eager to get to know them. Please let us know if there is anything else in your child’s experience that you would like to share with us so that we can better meet your child’s needs.
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