2020 / 2021 School Year

    KidZone Hourly Playcare - Registration Form


    Alexander FergusonGlen MeadowsWestgateWildwood


    A.M.P.M.PD Day


    Before CareAfter CareB/APD Day

    *before care not available for Wildwood School*


    MaleFemale

    Parent/Guardian #1

    Parent/Guardian #2

    Contact and Release Information

    In the event of an emergency where I/We cannot be reached, I authorize the following persons to be contacted.

    Person 1

    Person 2

    Person 3

    Consent for Medical Treatment

    In the event I/We cannot be reached to make arrangements for emergency medical attention at the time of illness or accident, I give consent for KIDZONE to secure any and all necessary emergency medical care for my child.

    Immunization up-to-date

    YesNo

    Please list any additional information such as existing illness, allergies, previous serious illness, injuries during the past 12 months, any medications prescribed for long-term continuous use, and any other information which staff should be aware of.


    YesNo