2022-2023 School Year - Rebel Kids Care Registration Form

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School Age Childcare for district enrolled students K-5th grade only. Registration is NOT confirmed until you receive confirmation from the Community Education Office. Once you receive confirmation that we have room for your student/s, we will send you the enrollment forms and then you can submit your registration fee. If you have any questions, please contact Tracy Tollefson at 218-477-6805.

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E-mail *

Student First and Last Name *

Student Grade *

Kindergarten (Finished Kindergarten or Enrolled for 2022-2023 School Year)

1st

2nd

3rd

4th

5th

Student Birthdate *

AAAA

Classroom Teacher - Students will not know their teacher for next year yet so leave this field blank if you are unsure.

Allergies (If no allergies, please write "None") *

Each child brings their own uniqueness to the program. If your child receives services through Special Education, or has a behavior plan developed, please contact Tracy Tollefson at 218-477-6805 or rebelkidscare@dgf.k12.mn.us. A meeting will need to be set up with you to do an individualized assessment regarding your request to have your child participate in Rebel Kids Care. This meeting will determine if Rebel Kids Care is an appropriate and safe setting for your child to succeed independently. The child’s start date may be delayed depending on the number or staff available with the skill-set necessary to meet your child’s needs.

My child receives Special Ed Services

My child does not receive Special Ed Services

Address *

City *

State *

Parent First and Last Name *

Parent Email *

Parent Cell Phone

Requested Enrollment Information: Please note what care you are requesting. Priority is given to full time enrollment. Parents can pay for full time but attend less to prioritize their child's enrollment. Once we review your request form, we will notify you if we have room or if your child needs to be added to the waitlist.

Before School Care - Full Time 5 days per week (Pay for 5 days per week but can attend less)

Before School Care - Part Time - Less than 5 days per week

After School Care - Full Time 5 days per week (Pay for 5 days per week but can attend less)

After School Care - Part Time - Less than 5 days per week

Before and After School Care - Full Time 5 days per week (Pay for 5 days per week but can attend less)

Before and After School Care - Part Time - Less than 5 days per week

Non School Days - Full Days

Summer Care - Full Time 5 days per week (Pay for 5 days per week but can attend less)

Summer Care - Part Time - Less than 5 days per week

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