Please fill out the registration form below for Before/After School care or print the registration form by clicking here. Note: this is just an application form.  This does not guarantee a spot in our program.  Kids Connection will contact you by email to follow up.

Child Information

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Parent Information

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Pickup Permission

I give permission for the following people to pick up my child from Kids Connection (note: photo id will be required for picking up a child).

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Health Information

 

Emergency Medical Consent: I hereby give permission for the Supervisor and staff of Kids Connection to act on my
behalf in obtaining and/or authorizing medical treatment if an emergency arises and I cannot be contacted by telephone.
I understand that any treatment would be on the advice of a qualified medical doctor. Children are not to
bring medication to center. Staff do not administer drugs.

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Fee Information and Payment Options