Camp Kindergarten Registration
FOR MORE INFORMATION Call Phillip Caudill at 606-327-2706.  Office hours are 8:00-4:00.
To apply for Camp Kindergarten, complete the application form below and submit.  To complete registration, you must send to the school the child's Birth Certificate and Immunization Record prior to the registration deadline.

Due to limited space, this application does not guarantee enrollment.  

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Email *
School of Choice *
Child's First Name *
Child's Last Name *
Birth date *
MM
/
DD
/
YYYY
Gender *
Parent/Guardian's First Name *
Parent/Guardian's Last Name *
Phone Number (home)
Phone Number (cell)
Phone Number (work)
Address (include city, state, and zip code)
Transportation - mark all that apply *
Required
If transportation to camp was marked above please list the address of the pickup location.
If transportation to home was marked above please list the address of the drop-off location.
List two people who are allowed to pick-up your child from Camp Kindergarten and their Phone Numbers. *
In case of emergency, list two people school officials can contact if unable to reach the parent/guardian.  Include Name, Relationship, Phone Number *
Has your child attended Preschool or Head Start? *
If you marked Yes above please list the name of the Preschool or Head Start center your child attended.
Has your child been identified with special needs? *
List any allergies your child has
List any medical or physical concerns
What is the primary language(s) spoken in your home? *
I give permission for my child to be photographed or videotaped for any purpose such as educational, training, etc. *
My child has permission to attend any field trips during Camp Kindergarten. *
I am aware my child may be exited from the program if his/her behavior or needs interfere with his/her meaningful participation or threaten his/her welfare or the welfare of others. *
In the event of illness or accident to a child of mine while attending school which, in the judgment of the principal of the school, or his/her authorized designee, would seem to require medical attention, I hereby authorize the principal or designee to secure medical services for my child, at my expense, including doctor, hospital, and ambulance services, if I cannot be reached promptly by phone, or, if in the judgment of the principal of the school, medical help is immediately required without time to reach me.   *
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