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CKS Kids Club Handbook

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- CHRIST THE KING
  SUMMER KIDS CLUB PROGRAM HANDBOOK
  Welcome to Christ the King Daycare and Preschool! My name is Makayla Grossman, and I am the Kids Club director. If you have any questions or concerns, please do not hesitate to reach out to me. I can be
  reached at 515-953-4327 or at [email protected].
  
  HOURS OF OPERATION
  Kids Club is open from 6:30 am to 5:45 pm. Please ensure that your child is picked up by 5:45 pm to avoid additional charges.
  
  PICK UP AND DROP OFF
  We ask that you drop off and pick up your child at the Kids Club building just north of the school at the end of the church parking lot. If you arrive after breakfast and we are somewhere else, there will be a sign posted on the door window. Please make sure you sign them in and out when they arrive and leave on the Playground app. To ensure the safety of your child and all other children, you assume full responsibility for your child
  while you are on our campus. If your child has a temp at or above 100.4, they will immediately be sent home. It is very important for the overall health of our students and the success of the program that you leave your children at home if they are ill. If picking your child up in the gym, please do not enter the gym. Open the door to let your child and staff know you are there. Please wait at the door for them to collect their things.
  
  MEALS
  Each family is to provide the sack lunch for their child(ren) each day. If you forget lunch for your child, we will provide lunch for a charge of $5.00 per meal. We do not have enough refrigerator space for all kids, so please plan accordingly with ice packs, if needed.
  
  SUPPLIES
  We ask that you supply the following for your child:
  
  Bottle of sunscreen and a face stick - please label with your child’s name
  
  Water bottle - This can be kept at the Kids Club or brought daily. Your child can bring this outside with them and down to the gym. Please label it with your child’s name.
  
  Change of clothes (K-2) - In case of accidents, make sure all items of clothing are labeled as well.
  
  Kids are not allowed to bring toys from home; this includes electronics.
  
  PAYMENTS
  Kids Club fees will be paid through the FACTS system. If you do not have a FACTS account, please visit https://online.factsmgt.com/signin/3ZB4C and create an account.
  If your payments become delinquent for two or more weeks, you may be asked to immediately withdraw your child.
  
  FEES
  Full-time - $215 per week
  ● This includes all field trips and activities (not including optional swim lessons) and provided snacks
  ● $25 per week discount for the second child in a given household.
  Late Fees
  ● Kids Club closes at 5:45. If your child is picked up after 5:45, there will be a $5 per minute charge applied to your account.
  
  NOTICE OF WITHDRAWAL
  If for any reason you would like to withdraw your child from Kids Club, you need to provide a two-week written notice to the Kids Club Director.
  
  BULLYING AND HARASSMENT POLICY
  Kids Club will not tolerate any form of bullying. If there is a physical form of bullying or a series of harming others your child will be asked to leave immediately for the remaining time of the summer program. If there is a continuing form of harassment or emotional harm from said child onto others they will be asked to leave immediately for the remaining time of the summer program.
  
  CELL PHONE POLICY
  Kids Club holds the same policy as Christ the King School. If your child is using their cell phone while at Kids Club, the phone will be taken from your child and the staff member will return it to the parent or guardian. If the phone is taken a second time, the school will maintain possession of the phone throughout the summer.
  
  DISCIPLINE POLICY
  If a child for any reason is not following the rules established by Christ the King, the student will be disciplined in a manner appropriate for your child. If the behavior continues or becomes excessive, abusive, disrespectful, disruptive, etc. the Kids Club Director will send the student home and hold a meeting with the parents to establish a plan of action for the child which may include withdrawal from Kids Club at the administrator’s sole discretion.
  
  COMMUNICATION
  Kids Club will use Playground to communicate with parents. Playground will be used to show pictures of activities, share news and updates as well as keep track of student behavior. It will also be the way you check your child in and out.
  
  MEDICATION
  Kids Club can administer prescription medication to your child(ren) in agreement with a signed medication form. Over-the-counter medication can only be given if prescribed by a doctor. A written and signed authorization is required. Medication needs to be in the original container and clearly labeled with the child’s name, name of the medication, dosage, and instructions for administration and storage.
  
  DATES
  Kids Club will operate from 5/30 - 8/11, Monday through Friday.
  Kids Club will be closed on May 29th in observance of Memorial Day.
  Kids Club will be closed on July 4th in observance of Independence Day
- PARENT AGREEMENT
  Please fill out the following form.
- PARENT AND CONTACT INFORMATION
- Mother's Name (First and Last) REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Home Phone Number Maximum 20 characters Please enter a phone number.
- Office Phone Number Maximum 20 characters Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Place of Employment REQUIRED Please fill out this field. Please enter valid data.
- Father's Name (First and Last) REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Home Phone Number Maximum 20 characters Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Office Phone Number Maximum 20 characters Please enter a phone number.
- I have read and understand all the policies and procedures listed in the Christ the King Before and After School Handbook, including: REQUIRED Drop Off and Pick Up Policies Notifying Teachers and Director in Case of Absence Withdrawl from the Program Requirements and Responsibilities Discipline Policy Please fill out this field.
- Names of People responsible for Tuition Payments REQUIRED Please fill out this field.
- The Above People Listed are responible for tuition payments REQUIRED I Agree Please fill out this field.
- CHILD RELEASE INFORMATION
- I (WE), give permission to the person or persons named below to pick up my child(ren) from Christ the King Kids Club in my absence. I understand that the individual may be required to provide photo identification before my child(ren) will be released. My child(ren) will not be allowed to leave with any other individual without my specific written permission.
- I (we) Agree to the Above REQUIRED Agree Please fill out this field.
- Approved Pick Up Individuals REQUIRED Please fill out this field.
  
  Approved PIck Up Individual 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  This person can be contacted in the event of an emergency and the parent(s) cannot be reached REQUIRED Yes No Please fill out this field.
  
  Approved PIck Up Individual 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  This person can be contacted in the event of an emergency and the parent(s) cannot be reached REQUIRED Yes No Please fill out this field.
  
  Approved PIck Up Individual 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  This person can be contacted in the event of an emergency and the parent(s) cannot be reached REQUIRED Yes No Please fill out this field.
  
  Approved PIck Up Individual 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  This person can be contacted in the event of an emergency and the parent(s) cannot be reached REQUIRED Yes No Please fill out this field.
  
  Approved PIck Up Individual 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  This person can be contacted in the event of an emergency and the parent(s) cannot be reached REQUIRED Yes No Please fill out this field.
- Number of Children Registering REQUIRED Please fill out this field.
  
  Child 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering Next Fall REQUIRED Please fill out this field.
  
  Shirt Size for Your Child REQUIRED Please fill out this field.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medicaitons Taken On a Daily Basis REQUIRED Please fill out this field.
  
  Allegires REQUIRED Please fill out this field.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dentist's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Dentist's hone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Hosptial Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Any Existing Illness(es) REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Previous Injuries REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Hospitalization(s) in the Past 12 Months REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medications REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Restrictions to Physical Activity? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medical Conditions Requiring Dietary Suppliments, Medications, or Avoidance of Allergies? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  I hereby grant permission for the Director or other qualified staff member to take whatever steps may be necessary to obtain emergency medical care if necessary. REQUIRED I Agree Please fill out this field.
  
  Field Trips, Photographs, Media, and Sunscreen Information
  
  Christ the King Kids Club may schedule a field trip. Children may either take part in such field trips or remain at Kids Club depending upon the wishes of the parent. Notice of any field trip will be communicated at least three days in advance. The undersigned parent or guardian gives permission to Christ the King Kids club to include his or her child(ren) in such field trips unless they specifically advise the teacher or center in writing.
  
  The undersigned parent or guardian gives permission to Christ the King Kids Club to photograph his or her son or daughter and use the resulting photographs for parent communication on Playground.
  
  I hereby give permission to apply the sunscreen I have provided.
  
  Permissions (Please Check All That Apply) REQUIRED Field Trips Photography and Media Sunscreen Please fill out this field.
  
  Child 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering Next Fall REQUIRED Please fill out this field.
  
  Shirt Size for Your Child REQUIRED Please fill out this field.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medicaitons Taken On a Daily Basis REQUIRED Please fill out this field.
  
  Allegires REQUIRED Please fill out this field.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dentist's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Dentist's hone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Hosptial Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Any Existing Illness(es) REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Previous Injuries REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Hospitalization(s) in the Past 12 Months REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medications REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Restrictions to Physical Activity? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medical Conditions Requiring Dietary Suppliments, Medications, or Avoidance of Allergies? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  I hereby grant permission for the Director or other qualified staff member to take whatever steps may be necessary to obtain emergency medical care if necessary. REQUIRED I Agree Please fill out this field.
  
  Field Trips, Photographs, Media, and Sunscreen Information
  
  Christ the King Kids Club may schedule a field trip. Children may either take part in such field trips or remain at Kids Club depending upon the wishes of the parent. Notice of any field trip will be communicated at least three days in advance. The undersigned parent or guardian gives permission to Christ the King Kids club to include his or her child(ren) in such field trips unless they specifically advise the teacher or center in writing.
  
  The undersigned parent or guardian gives permission to Christ the King Kids Club to photograph his or her son or daughter and use the resulting photographs for parent communication on Playground.
  
  I hereby give permission to apply the sunscreen I have provided.
  
  Permissions (Please Check All That Apply) REQUIRED Field Trips Photography and Media Sunscreen Please fill out this field.
  
  Child 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering Next Fall REQUIRED Please fill out this field.
  
  Shirt Size for Your Child REQUIRED Please fill out this field.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medicaitons Taken On a Daily Basis REQUIRED Please fill out this field.
  
  Allegires REQUIRED Please fill out this field.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dentist's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Dentist's hone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Hosptial Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Any Existing Illness(es) REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Previous Injuries REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Hospitalization(s) in the Past 12 Months REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medications REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Restrictions to Physical Activity? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medical Conditions Requiring Dietary Suppliments, Medications, or Avoidance of Allergies? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  I hereby grant permission for the Director or other qualified staff member to take whatever steps may be necessary to obtain emergency medical care if necessary. REQUIRED I Agree Please fill out this field.
  
  Field Trips, Photographs, Media, and Sunscreen Information
  
  Christ the King Kids Club may schedule a field trip. Children may either take part in such field trips or remain at Kids Club depending upon the wishes of the parent. Notice of any field trip will be communicated at least three days in advance. The undersigned parent or guardian gives permission to Christ the King Kids club to include his or her child(ren) in such field trips unless they specifically advise the teacher or center in writing.
  
  The undersigned parent or guardian gives permission to Christ the King Kids Club to photograph his or her son or daughter and use the resulting photographs for parent communication on Playground.
  
  I hereby give permission to apply the sunscreen I have provided.
  
  Permissions (Please Check All That Apply) REQUIRED Field Trips Photography and Media Sunscreen Please fill out this field.
  
  Child 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering Next Fall REQUIRED Please fill out this field.
  
  Shirt Size for Your Child REQUIRED Please fill out this field.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medicaitons Taken On a Daily Basis REQUIRED Please fill out this field.
  
  Allegires REQUIRED Please fill out this field.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dentist's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Dentist's hone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Hosptial Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Any Existing Illness(es) REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Previous Injuries REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Hospitalization(s) in the Past 12 Months REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medications REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Restrictions to Physical Activity? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medical Conditions Requiring Dietary Suppliments, Medications, or Avoidance of Allergies? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  I hereby grant permission for the Director or other qualified staff member to take whatever steps may be necessary to obtain emergency medical care if necessary. REQUIRED I Agree Please fill out this field.
  
  Field Trips, Photographs, Media, and Sunscreen Information
  
  Christ the King Kids Club may schedule a field trip. Children may either take part in such field trips or remain at Kids Club depending upon the wishes of the parent. Notice of any field trip will be communicated at least three days in advance. The undersigned parent or guardian gives permission to Christ the King Kids club to include his or her child(ren) in such field trips unless they specifically advise the teacher or center in writing.
  
  The undersigned parent or guardian gives permission to Christ the King Kids Club to photograph his or her son or daughter and use the resulting photographs for parent communication on Playground.
  
  I hereby give permission to apply the sunscreen I have provided.
  
  Permissions (Please Check All That Apply) REQUIRED Field Trips Photography and Media Sunscreen Please fill out this field.
  
  Child 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering Next Fall REQUIRED Please fill out this field.
  
  Shirt Size for Your Child REQUIRED Please fill out this field.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medicaitons Taken On a Daily Basis REQUIRED Please fill out this field.
  
  Allegires REQUIRED Please fill out this field.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dentist's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Dentist's hone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Hosptial Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Any Existing Illness(es) REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Previous Injuries REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Hospitalization(s) in the Past 12 Months REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medications REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Restrictions to Physical Activity? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medical Conditions Requiring Dietary Suppliments, Medications, or Avoidance of Allergies? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  I hereby grant permission for the Director or other qualified staff member to take whatever steps may be necessary to obtain emergency medical care if necessary. REQUIRED I Agree Please fill out this field.
  
  Field Trips, Photographs, Media, and Sunscreen Information
  
  Christ the King Kids Club may schedule a field trip. Children may either take part in such field trips or remain at Kids Club depending upon the wishes of the parent. Notice of any field trip will be communicated at least three days in advance. The undersigned parent or guardian gives permission to Christ the King Kids club to include his or her child(ren) in such field trips unless they specifically advise the teacher or center in writing.
  
  The undersigned parent or guardian gives permission to Christ the King Kids Club to photograph his or her son or daughter and use the resulting photographs for parent communication on Playground.
  
  I hereby give permission to apply the sunscreen I have provided.
  
  Permissions (Please Check All That Apply) REQUIRED Field Trips Photography and Media Sunscreen Please fill out this field.
  
  Child 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering Next Fall REQUIRED Please fill out this field.
  
  Shirt Size for Your Child REQUIRED Please fill out this field.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medicaitons Taken On a Daily Basis REQUIRED Please fill out this field.
  
  Allegires REQUIRED Please fill out this field.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dentist's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Dentist's hone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Hosptial Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Any Existing Illness(es) REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Previous Injuries REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Hospitalization(s) in the Past 12 Months REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medications REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Restrictions to Physical Activity? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medical Conditions Requiring Dietary Suppliments, Medications, or Avoidance of Allergies? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  I hereby grant permission for the Director or other qualified staff member to take whatever steps may be necessary to obtain emergency medical care if necessary. REQUIRED I Agree Please fill out this field.
  
  Field Trips, Photographs, Media, and Sunscreen Information
  
  Christ the King Kids Club may schedule a field trip. Children may either take part in such field trips or remain at Kids Club depending upon the wishes of the parent. Notice of any field trip will be communicated at least three days in advance. The undersigned parent or guardian gives permission to Christ the King Kids club to include his or her child(ren) in such field trips unless they specifically advise the teacher or center in writing.
  
  The undersigned parent or guardian gives permission to Christ the King Kids Club to photograph his or her son or daughter and use the resulting photographs for parent communication on Playground.
  
  I hereby give permission to apply the sunscreen I have provided.
  
  Permissions (Please Check All That Apply) REQUIRED Field Trips Photography and Media Sunscreen Please fill out this field.
  
  Child 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering Next Fall REQUIRED Please fill out this field.
  
  Shirt Size for Your Child REQUIRED Please fill out this field.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medicaitons Taken On a Daily Basis REQUIRED Please fill out this field.
  
  Allegires REQUIRED Please fill out this field.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dentist's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Dentist's hone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Hosptial Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Any Existing Illness(es) REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Previous Injuries REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Hospitalization(s) in the Past 12 Months REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medications REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Restrictions to Physical Activity? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medical Conditions Requiring Dietary Suppliments, Medications, or Avoidance of Allergies? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  I hereby grant permission for the Director or other qualified staff member to take whatever steps may be necessary to obtain emergency medical care if necessary. REQUIRED I Agree Please fill out this field.
  
  Field Trips, Photographs, Media, and Sunscreen Information
  
  Christ the King Kids Club may schedule a field trip. Children may either take part in such field trips or remain at Kids Club depending upon the wishes of the parent. Notice of any field trip will be communicated at least three days in advance. The undersigned parent or guardian gives permission to Christ the King Kids club to include his or her child(ren) in such field trips unless they specifically advise the teacher or center in writing.
  
  The undersigned parent or guardian gives permission to Christ the King Kids Club to photograph his or her son or daughter and use the resulting photographs for parent communication on Playground.
  
  I hereby give permission to apply the sunscreen I have provided.
  
  Permissions (Please Check All That Apply) REQUIRED Field Trips Photography and Media Sunscreen Please fill out this field.
  
  Child 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering Next Fall REQUIRED Please fill out this field.
  
  Shirt Size for Your Child REQUIRED Please fill out this field.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medicaitons Taken On a Daily Basis REQUIRED Please fill out this field.
  
  Allegires REQUIRED Please fill out this field.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dentist's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Dentist's hone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Hosptial Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Any Existing Illness(es) REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Previous Injuries REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Hospitalization(s) in the Past 12 Months REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medications REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Restrictions to Physical Activity? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medical Conditions Requiring Dietary Suppliments, Medications, or Avoidance of Allergies? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  I hereby grant permission for the Director or other qualified staff member to take whatever steps may be necessary to obtain emergency medical care if necessary. REQUIRED I Agree Please fill out this field.
  
  Field Trips, Photographs, Media, and Sunscreen Information
  
  Christ the King Kids Club may schedule a field trip. Children may either take part in such field trips or remain at Kids Club depending upon the wishes of the parent. Notice of any field trip will be communicated at least three days in advance. The undersigned parent or guardian gives permission to Christ the King Kids club to include his or her child(ren) in such field trips unless they specifically advise the teacher or center in writing.
  
  The undersigned parent or guardian gives permission to Christ the King Kids Club to photograph his or her son or daughter and use the resulting photographs for parent communication on Playground.
  
  I hereby give permission to apply the sunscreen I have provided.
  
  Permissions (Please Check All That Apply) REQUIRED Field Trips Photography and Media Sunscreen Please fill out this field.
  
  Child 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Grade Entering Next Fall REQUIRED Please fill out this field.
  
  Shirt Size for Your Child REQUIRED Please fill out this field.
  
  Insurance Company REQUIRED Please fill out this field. Please enter valid data.
  
  Medicaitons Taken On a Daily Basis REQUIRED Please fill out this field.
  
  Allegires REQUIRED Please fill out this field.
  
  Physician's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Physician's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Dentist's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Dentist's hone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Hosptial Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Any Existing Illness(es) REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Previous Injuries REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Hospitalization(s) in the Past 12 Months REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medications REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Restrictions to Physical Activity? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  Any Long Term Medical Conditions Requiring Dietary Suppliments, Medications, or Avoidance of Allergies? REQUIRED Please fill out this field.
  
  If Yes Please Explain
  
  I hereby grant permission for the Director or other qualified staff member to take whatever steps may be necessary to obtain emergency medical care if necessary. REQUIRED I Agree Please fill out this field.
  
  Field Trips, Photographs, Media, and Sunscreen Information
  
  Christ the King Kids Club may schedule a field trip. Children may either take part in such field trips or remain at Kids Club depending upon the wishes of the parent. Notice of any field trip will be communicated at least three days in advance. The undersigned parent or guardian gives permission to Christ the King Kids club to include his or her child(ren) in such field trips unless they specifically advise the teacher or center in writing.
  
  The undersigned parent or guardian gives permission to Christ the King Kids Club to photograph his or her son or daughter and use the resulting photographs for parent communication on Playground.
  
  I hereby give permission to apply the sunscreen I have provided.
  
  Permissions (Please Check All That Apply) REQUIRED Field Trips Photography and Media Sunscreen Please fill out this field.
- Please Electronically Sign and Date this form to indicate your permissions outlined above and that the information above is true to the best of your ability.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Please Enter Your Email to Record Your Signature REQUIRED Please fill out this field. Please enter an email address.
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