Student Enrollment Application

Student Enrollment Application

Student's Information

Mother's Information (Guardian #1)

Father's Information (Guardian #2)

Emergency Contact Information

(other than Parents/Guardians mentioned above.)

First Contact

Second Contact

These emergency contacts listed above will be allowed to pick up your child, and do not need to be listed below in the next section of additional parental authorizations.

Additional Parental Authorizations

Kid Academy will only release your child to those listed on this application unless we received WRITTEN authorization from parents IN PERSON. Anyone unfamiliar will be asked to show picture identification. This policy is strictly enforced for the safety of our students.

Special information concerning student's growth development and needs

Private Physician or Medical Provider Information

Emergency Medical Treatment (must sign)

Sign Here

Photography Permission (must sign. Can request no social media)

Sign Here

Field Trip Permission

Sign Here

Parent Referral

If you were referred by a parent of Kid Academy, past or present, please provide their name and child's name below