little learners Registration form Name * First Name Last Name Email * Subject * Class or event you are registering your child for? * Thank you! Child’s Name: * Date of Birth * Age * Gender * Please check one F M Home Address: * Name (s) of Parent/Guardian * Email Address * Work * Cell Phone * Place of work * Phone Number * Name of another person authorized to pick up your child if different from the above Full Name * Tel No * Emergency Purposes Name and telephone number of other person(s) that could be contacted in case of an emergency: Name * Tel No * Relationship * Name * Tel No * Relationship * Medical Information Child’s primary care doctor Tel No Preferred hospital in case of an emergency Any known medical problems or allergies: Any special needs? Any additional information you want us to know about your child? Signature I understand that I will need pay The Kids Social Club $ Parents will remain diligent and keep their children home if the parent or child has any of the following criteria: - A temperature of 100.4 f or above. - Signs or symptoms of respiratory infection, such as cough, shortness of breath, sore throat, and low-grade fever. - In the previous 14 days has had contact with someone with a confirmed diagnosis of COVID-19; or is ill with any symptoms concerning for COVID-19. 2. Parents will help The Kids Social Club staff to minimize exposure of illness by: -Monitoring for any signs and symptoms of illness. -Considering the health and safety of other children and staff by keeping children with symptoms of illness or possible exposure to COVID-19 at home. -Ensuring emergency contact information provided is accurate and a parent is accessible. -Responding quickly to communications from our center. -Promptly responding to requests to pick up children with signs of illness. -Report any signs of illness to The Kids Social club. -Report any exposure to someone with a confirmed diagnosis of COVID-19 or any other illness that is contagious and can affect others. 3. Once a student signs up for the class, it is our expectation that the student commits to our weekly schedule. 4. Drop offs classes start 5 minutes before the class starts. Please be on time. 5. Please arrive on time to pick up your child at the time of departure. 6. Please make sure you let our staff know if your child has any allergies. 7. You are required to pack a snack and a drink for your child. ParentSignature * Date * I accept Class Policies Thank you!
