Rebel Kids Care Registration Form
School Age Childcare for district enrolled students K-5th grade only.  Registration is NOT confirmed until you receive confirmation from the Community Education Office.
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Email *
Student First and Last Name *
Student Grade *
Student Birthdate *
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Classroom Teacher *
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.
Address *
City *
State *
Parent First and Last Name *
Parent Email *
Parent Cell Phone
Requested Enrollment Information (Once we review your registration, we will notify you if we have room or if your child needs to be added to the waitlist). *
1/2 Day Morning 7 am - 12 pm
1/2 Day Afternoon 12 pm-5:30 pm
Full Day - 5 days per week
Monday
Tuesday
Wednesday
Thursday
Friday
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