Kids Unite Enrollment Form
2019-2020 After-School Child Care
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Email *
Name of Student *
Male or Female
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Grade level for 2019-2020 school year
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Date of Birth of Student *
MM
/
DD
/
YYYY
Name of School *
Child lives with: *
Required
Primary Parent/Guardian Name *
Driver's license (state and number) *
Address *
What is your zip code? *
Phone Number (home, work, & cell) *
Secondary Parent/Guardian Name
Driver's license (state and number)
Address
Phone Number (home, work, & cell)
Emergency Contact other than Primary and Secondary Parent/Guardian *
Emergency Contact (Relationship to child)   *
Driver's license (state and number)
Address
Phone Number (home, work, & cell) *
Does anyone else have permission to pick up this child?  (If so, who and list their phone number.) *
Does this child have any medical or health concerns?  Is so, please describe. *
Required
Is your child capable of taking care of his/her own personal hygiene needs?   *
Required
Does your child have any special needs of which the staff should be aware?   *
Required
Does your child qualify for Special Education/504?     *
Required
Has your child ever suffered from asthma or any related breathing disorder?     *
Required
Does your child have allergies and/or allergic reactions to any foods, medications, or insect bites?   *
Required
Does your child have an existing illness and/or a previous serious illness or injury, or hospitalization during the past 12 months?     *
Required
I give permission for my child's work and/or photos of my child to be published in newspapers, magazines and/or any written or electronic publication, on the WISD and/or Community Ed website, blog, and social media such as Facebook, Instagram and Twitter.     *
It is understood by my child and me that all policies, regulations, and standards of the Weatherford Independent School District will be in effect and will be adhered to by my child.       *
I understand that ALL paperwork must be completed before my child may attend Kids Unite after school program.  If there are any changes during the school year, it is my responsibility to inform the KU staff in writing. *
I understand there is a $30 Registration Fee per family (not child) for the 2019-2020 school year.  This can only be waived if I paid it during the summer.  This will be added to my first week's payment.   *
I understand that I am responsible for paying every week my child is enrolled in KU.  Payments are due on each Thursday before the following week.  Kids Unite will accept cash, checks, money orders, Visa, Mastercard and Discover credit/debit.  Cash, Debit or Credit cards will only be accepted at the Community Education office, located at 900 North Elm Street, Weatherford, Texas  76086 or call 817-598-2806 to pay by phone.         *
I am interested in the automatic on-line payment plan.   *
Required
I am interested in the discounted rate.         *
Required
Students MUST be picked up by 6:30 p.m. I understand a charge of $1.00 per minute is the late fee.  (The campus clock will be the official timepiece.) *
I release Weatherford ISD from liability in case of an accident.  The staff has my permission to provide emergency health care if needed.  I understand that I am financially responsible for any expenses for medical care and /or transportation incurred on my student' behalf.  I have read and understand the about procedures and agree to comply with them.   *
My child will follow the rules for technology use while at Kids Unite. *
My child has permission to use the school internet. *
I have downloaded and read the Kids Unite Handbook with my child, including the policies, procedures and the discipline guidelines.  We agree to abide by the standards, policies and procedures defined or referenced in this document. *
I understand it is my responsibility to notify the school and my child's teacher of their attendance in the Kids Unite After School Program.  This includes the start date, end date, and any other days after school.   *
Please have the Kids Unite Supervisor call me.  I have questions or concerns.   (Please include name and phone number if you want the supervisor to contact you, otherwise skip this question. )
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