2020 KAC Youth Registration Form

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*Registration fee for youth programs are $25 per child*

Email *

Please select all that applies: *

Raising The Barre After school Dance Series (Series ends May 28th)

Going Green Spring Academy- $125 (April 13th- April 17th)

Spring Academy Before Care 7-9AM ($25)

Spring Academy After Care 4-5:30pm ($25)

Spring Academy Both Before and After Care ($40)

B.A.M.N After-School Filmmaking Program (Start Date 2020 TBA)

Black Arts Movement Summer Camp- $125 (June 8th- July 31st)

Required

Have you or your child participated in this program before?

Yes

Other:

Clear selection

Participants Name *

Address (City, State, Zip Code) *

Participants Date of Birth *

YYYY

Age *

Phone Number *

Parent/Guardian Name *

Parent/Guardian #2 Name *

Emergency Contact Information

Must be a parent or guardian if under 18 years of age

Name *

Relationship *

Address (if different from above, if the same type"Same") *

Phone number *

Phone number 2

Email Address (if same as above, enter "same") *

If primary Emergency Contact is unavailable, please provide a secondary contact

Name + Relationship + Phone Number *

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