R-P Summer Kids' Club Enrollment Form
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Registration Fee: $15/Family                         ----                                                             Transportation/Sunscreen Fee: $40/Child *
Childs' Name/Sex/Birthdate/Grade (2020-2021 school year): *
Childs' Name/Sex/Birthdate/Grade (2020-2021 school year):
Childs' Name/Sex/Birthdate/Grade (2020-2021 school year):
T-Shirt Size (optional):
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T-Shirt Payment ($7.00):
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Parent/Guardian #1: *
Parent/Guardian #1- Phone Number: *
Parent/Guardian #1- Email Address: *
Parent/Guardian #2:
Parent/Guardian #2- Phone Number:
Parent/Guardian #2- Email Address:
Alternate Emergency Contact (Name/Phone Number): *
Alternate Emergency Contact (Name/Phone Number):
List those authorized to pick up your child(ren):
Approximate Drop Off time:
Time
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Approximate Pick Up time:
Time
:
What day of the week do you need care?
Any special health needs/concerns? (medication, allergies, etc)
Kids are transported in school vehicles or/and buses during the summer when it is too far to walk to activities and/or field trips.  For kids under age 8, they will be sitting in a booster seat if they are transported in a school vehicle (Minnesota state law).  For kids who are 8 years old and up: parents will make the decision whether or not they would like their child to sit in a booster seat. Please enter your child(rens) names if they need a booster.
I understand that…Parent/ Guardian is responsible for the summer fees payable at the time of registration.  Billing charges begin the first day of scheduled care at Kids’ Club.  Registrants will be billed on a weekly basis.  All registrants must maintain an account with a reliable and conscientious payment history according to the Rushford-Peterson Kid’s Club Parent/ Guardian Handbook. Rushford-Peterson Kids’ Club closes at 6:00 pm.  Late fees are assessed and billed at $5.00 per child for every FIVE (5) MINUTES LATE beginning at 6:05 pm according to the Kids’ Club site clock, then progressing with each five-minute interval on the site clock (i.e., 6:10, 6:15,  etc.) I authorize the Emergency Contact Persons to be contacted in case of an emergency and/or to pick up my child(ren). I agree to permit my child to be transported in school vehicles by trained staff or in school buses by licensed drivers.  I agree to my child participating in field trips.  I grant permission for sunscreen to be applied while at Kids' Club.  I understand that my child will apply their own  sunscreen with direction from staff. I grant permission to Kids’ Club to use names, pictures, video, and anecdotes for the purpose of educating and promoting the services available. I have read, understand, and will comply with the Registration Agreement, and well as policies / procedures stated in the Rushford-Peterson Kids’ Club Parent/Guardian Handbook.
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