2023-24 Kids' Connection Registration
Before and after school childcare 
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Student Name *
School *
Fill in your student’s school here if you answered “Other”

We may not be able to serve your school if we don’t get enough enrollments. So invite other families to join too!
Grade *
Which childcare option are you applying for? *
Parent/Guardian Name *
Parent/Guardian Relationship *
Primary Email Address *
Primary Phone Number *
Basic Information
Before school care starts at 6:30am, after school ends at 6:00pm.
Prices are $600 for before AND after school care, $380 for before OR after.
The three (5 days/week) options above are the only options we are offering, but special circumstances may be reviewed if communicated in advance.
Monthly charges will not be adjusted for weather, vacations, illness, etc.
Monthly charges are divided evenly for the whole year, which may not always reflect the days of offered care in a given month (i.e. December).
All registration forms must be completed in order to process registration and hold your spot. This includes the state Certificate of Immunization Form.
This program will include the use of Bible stories, songs, and prayer.
Late pick up fees will be charged for children picked up later than 6:00. The fee is $10 for every 15 minutes.
If your student's school has a teacher in-service day, conferences, days off for holidays, or any other schedule that is different than the normal weekly schedule, Kids' Connection may be closed (The Ridge Activity Center is a great resource for camps).
I understand and agree to the above policies.

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Emergency Information
Contacts and permissions
Contact #1 Name *
Relationship to Student *
Primary Phone Number *
Secondary Phone Number
Contact #2 Name *
Relationship to Student *
Primary Phone Number *
Secondary Phone Number
Contact #3 Name
Relationship to Student
Primary Phone Number
Secondary Phone Number
I give my permission for any of the above individuals to be contacted and my child may be released to any of them. 
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 *
Child's medical care provider or preferred medical facility: *
Address of provider/facility: *
Phone number of provider/facility *
Child's dental care provider or preferred dental facility: *
Address of provider/facility: *
Phone number of provider/facility: *
Please communicate any allergies or other health conditions we should know about: *
I give my permission that my child may be given first aid/emergency treatment by the childcare licensee and/or qualified staff at Kids' Connection. 
(3805, Maltby Rd, Bothell, WA)

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When I cannot be contacted, I authorize and consent to medical, surgical and hospital care, treatment and procedures to be performed for my child by a licensed physician, healthcare provider, hospital or aid car attendant when deemed necessary or advisable by the physician or aid care attendant to safeguard my child's health. I waive my right of informed consent to such treatment. I also give my permission for my child to be transported by ambulance or aid car to an emergency center for treatment.

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 *
Questions
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