Kids Klub- Park City 2021-22 School Year Registration

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We are excited that you are interested in our after school program! Black Diamond Kids Klub is an after school program that transports your child from school to our facility. This program is for children ages 5-12. All of our staff members must pass a background check, complete training before they are in the classroom and attend monthly program trainings. We pick up your child from school and bring them back to our facility for an afternoon of fun! Your child will receive a nutritious snack when they get into the classroom. Then they can choose to play games, read or participate in the fun art/craft projects we have planned in our daily lesson plans. You can pick up your child any time between 4:00-6:00pm. If you would like your child to take a gymnastics, tumbling or ninja class while in our care you can sign them up and we will help them get to their class. Please fill out this form and submit it to hold your spot in our Kids Klub program. At this time we are going to be going to Jeremy Ranch, McPolin and Parley's Park. If your child attends another school please enter it into the form and we will open that school if we have enough students. We follow the Park City School District calendar and will be off when the schools are out of session. On some of the school breaks we may offer camp if there is enough interest. Please email kendall@blackdiamondgym.com if you have any further questions. We are excited to have your child in our program!

Email Address *

Parent(s) First Name *

Parent(s) Last Name *

Mailing Address (Street/City/State/Zip) *

Physical Address (if different than above)

Phone Numbers (Home/Cell/Work please) *

Emergency Contact Name (other than parent) *

Emergency Contacts Relationship to Student *

Emergency Contact Phone Number *

Student Name (First and Last) *

Sex *

Male

Female

Prefer not to say

Other

Child's Date of Birth *

YYYY

Please describe any special needs that your child may have: *

Allergies: *

Physician's Name and Number *

What school will your child be attending in the fall? *

Parley's Park

Jeremy Ranch

McPolin

Weilenmann

Other:

Which days will your child be attending? *

Monday

Tuesday

Wednesday

Thursday

Friday

Other:

Required

Please check the boxes to agree to the following: *

Kids Klub After School requires a deposit/registration fee of $199.00. I understand that my card on file will be charged when I submit this form to hold my child's spot for the 2021-22 school year.

Withdrawals from the program MUST BE SUBMITTED IN WRITING to the front desk 4 WEEKS prior to the actual drop date. Verbal drop notices to teachers or via phone will not be accepted.

All deposits are non-refundable and must be included with all completed paperwork in order to guarantee after school care reservation. If you do not have not been registered in classes with Black Diamond previously, you will need to click on the link below to create a Jackrabbit Account so you can be billed the registration fee and monthly billing fees. This must be done within 24 hours of submitting this form.

Required

For Jackrabbit billing/registration, please click on the link below. You will not be able to 'Register' for Right Start via the link, you will only register your information and your child's information. Thank you! https://app.jackrabbitclass.com/regv2.asp?id=513074

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