Kids Care After School Program 2023-2024
Kids Care After School Program 2023-2024
1
Child Info
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2
Parent/Guadiran Info
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3
Pick Up Persons
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4
Emergency Contacts
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5
Policies
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6
Signature
Child Information
Membership
*
Membership
New
Renewing
Gender
*
Gender
Female
Male
Child's School
Child's School
Austin
Buice
Burleson
Burnet
Cameron
Gonzales
Greenwood Elementary
Greenwood Intermediate
Jordan
Pease
Ross
Name
Name
*
First
Middle
Last
Date of Birth
Date of Birth
*
/
MM
/
DD
YYYY
Child's Age
*
Address
Address
*
Street Address
City
Zip
Child's Medical Information
***PLEASE WRITE NONE OR SPECIFY WHERE NEEDED***
Food-Medication Allergies
*
Current Medications
*
Physical/Developmental Disability
*
Activities my child is unable to participate in
*
Current Immunization, Vision and Hearing Records are on file at
*
Photo/Media Permission
I give permission for my child to be included in promotional/ media resources, pictures, recordings regarding Camp Fire West Texas Kids Care program
*
I give permission for my child to be included in promotional/ media resources, pictures, recordings regarding Camp Fire West Texas Kids Care program
Yes
No
Do you have any siblings in the program?
*
Do you have any siblings in the program?
Yes
No
Siblings' full name:
*