2021/2022 Registration Form

Enrollment for 2021/2022 School Year: Please note Club K must meet daily minimum enrollment numbers in order to operate. You will be advised with a detailed confirmation email when your registration has been accepted.

Primary Account Person

First Name *

M.I.

Last Name *

Relationship to Child *

Gender

Male

Female

Current School Child(ren) Attends *

Address

Street Address *

City *

State *

Zip Code *

Mailing Type *

Physical

Mailing

Phone Number (no dashes or spaces required)

Phone Number *

Emergency Contact Information (Must be at least 18 years old. Must be different than above)

Name *

Phone Number *

Relationship to Child *

Name *

Phone Number *

Relationship to Child *

Acknowledgement

I agree to pay a non-refundable enrollment/registration fee of $85.00 per child. I understand this fee is collected upon child care enrollment/re-enrollment for each program.

I agree to pay a deposit of $200 collected upon enrollment. I understand that this payment will be applied to my last payment at the end of my contract or upon my 30 day notice to withdraw.

TUITION RATE INFORMATION

Payments are due in advance of care as noted on the rate sheet and in the confirmation email. Monthly tuition will be withdrawn on the 1st of each month.

Tuition is calculated and amortized for the entire program. Prorations, discounts, and attendance factors are built into the program rates. Our rates are structured by the enrollment space reserved rather than the amount of time used. Tuition is not reduced due to absences, vacations, suspensions, weather related closures, school district closures/delays, the Covid-19 Pandemic, holidays, etc. Credits are not issued and funds are non-transferrable for withdrawals that occur outside of the termination policy date range (see Termination below for details).

TUITION PAYMENT VIA TUITION EXPRESS (EFT)

Tuition is paid via secure Electronic Funds Transfer (ETF) on the first day of the month. A $50.00 late charge will apply 5 days after the tuition due date or for any returned payments. The program tuition amount is divided into equal payments and is based on the care days available. I give permission for Club K After School Zone to draft deposits/fees from my Tuition Express® account. Deposits, registration fees and tuition payments are non-refundable and non-transferable. For current/returning families: my financial information on file is current. I will notify Club K 10 days in advance if my banking institution, account, or persons on the account have changed. A new Tuition Express Form must be completed. I authorize Club K After School Zone to initiate debit entries to my Checking or Savings account indicated on the Tuition Express Form.

RETURNED PAYMENTS

A fee of $35 will be collected for all first time returned payments. The second time a payment returns, $50 will be collected. If Club K receives two (2) returned payments, regardless of the reason, I understand there may be an interruption of care and my child may be disenrolled from the program.

DELINQUENT ACCOUNTS

Any fees or charges incurred due to a delinquent account or an outstanding balance after withdrawal from the program will be subject to collection action. There will be an added fee of $250 on any account turned over to a collection agency to cover the costs of collection, attorney fees, etc.

LATE PICK UP FEE

The late pick up fee begins at 1 minute after your designated program plan time ends and is $20.00 plus $1 per minute per child up to the first 15 minutes. Beginning at 16 minutes after your designated program plan time ends, an additional $20 charge plus $1 per minute per child for the next 15 minutes will apply. The $20 fee will be charged in 15 minute increments in addition to the $1 per minute late fee. The fee is due and payable via EFT the next business day. If I am late more than 3 times, my child may be disenrolled.

HOLIDAYS & CLOSURES

Refer to our Program Calendar for specific closure dates.

TERMINATION

This Agreement may not be cancelled during the program. I understand that registration is by program and I am not obligated to register for other programs moving forward. Club K After School Zone and Kids Kastle on Campus, Inc. reserve the right to terminate this Agreement at any time.

Acknowledgement

I have received, read and understand the information contained in the Family Handbook, Tuition Rate Sheet, and in this Tuition Agreement. I agree and understand I am bound by the terms and conditions of these documents. By typing/signing my name below and electronically submitting my registration to Club K After School Zone, I certify the information is true and correct and I Agree to the terms and conditions of my child participating in the Club K After School Zone program.

Code of conduct

By checking this box you confirm that you have read and agreed to Club K's Parent Code of conduct.

Code of conduct

By checking this box you confirm that you have read and agreed to Club K's Student Code of conduct.

Code of conduct

By checking this box you confirm that you have read and agreed to Club K's Family Handbook Code of conduct [English] | [Spanish].

Consent

I certify that I am the parent or legal guardian of the student(s) named above. By signing below I agree to the following and give permission for my child to:

Use all age appropriate equipment and participate in all activities provided by the program.
Participate in field trips or excursions by bus as well as on neighborhood walking excursions. I understand that if my child does not have permission to attend all the program field trips, I will need to make alternate childcare arrangements on those days.
Be photographed and videotaped by Club K staff for marketing and staff training purposes including social media, website, brochures, displays, bulletin boards. I understand that no names will be used in photographs.
View G and/or PG rated movies under Club K After School Zone staff supervision.
My child(ren) may participate in water play activities. Swimming is a separate program that requires a separate waiver.
In order to add or delete authorized pick-ups or contacts, an Information Update Form must be submitted to the Main Office prior to the pick-up date. Authorizations must be in writing, verbal authorizations are not accepted.
There are no persons legally restricted from picking up my child from care or having access to my child. NOTE: If there are, Club K requires court documentation (ex: current court ordered custody agreement, restraining order) prior to your child beginning the program.
Grant permission for Club K After School Zone staff to apply Rocky Mountain Sunscreen® to my child.
To exchange information between Club K After School Zone, school personnel and my child’s teacher in the best interest of my child with regard to homework and/or behavior.
Grant permission for Club K staff to take whatever steps may be necessary to obtain emergency medical care if warranted. These steps may include, but are not limited to the following: a)attempt to contact parent, b) attempt to contact persons listed on the Registration Form, c) in most cases, 911 is called and the child is transported to the nearest hospital and treated by the on-call physician; the parent or guardian of the child is notified immediately.
Authorize Club K After School Zone staff to take whatever emergency measures (first aid, disaster evacuation or drills, 911 emergency) are deemed necessary for the care and protection of my child. If the situation warrants, I consent to have my child transported and treated by a physician/hospital at my expense. I will assume full financial responsibility for all medical services deemed necessary at that time.
Agree to release and hold harmless Club K After School Zone, its employees and agents, from any loss or damage to toys, clothes, or other personal items or articles.
Relieve Club K After School Zone, its employees and agents, of all responsibility for accidents and injuries, claims, damages, or other liabilities for injuries to or damage by my child both on and off the premises which are not a result of gross negligence by the program, its employees or agents.
The undersigned parent or guardian acknowledges and agrees that neither Club K After School Zone, nor any facilitator or employee of Club K After School Zone shall be held liable for any occurrence in connection with participation in the program that may result in injury or other damage to the participant named above. The undersigned further agrees to indemnify and hold harmless Club K After School Zone and all persons associated with it from any claim arising out of participant’s participation in any recreational, field trip or education program of Club K After School Zone.
Grant permission to Club K to send alerts and critical updates via text message.

COVID-19 Specific Requirements

To wear face-covering for required parts of the day
To participate in Wellness Screening daily which includes temperature monitoring
To participate in necessary screen time related to comprehensive distance learning activities;
Adhere to Club K's travel restrictions as outlined in the Health Screen Form;

ACKNOWLEDGEMENT

By typing/signing my name below and electronically submitting my registration to Club K After School Zone, I certify the information is true and correct and I agree to the terms and conditions of my child participating in the Club K After School Zone program.

Signature

Clear

Printed Name

Today's Date

If you have the following forms, please upload them below:

Court Order/Custody Order/Parenting Time Order/Restraining Order
IEP/504
Medical Protocol

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2021/2022 Registration Form

By checking this box you confirm that you have read and agreed to Club K's Parent Code of conduct.

By checking this box you confirm that you have read and agreed to Club K's Student Code of conduct.

By checking this box you confirm that you have read and agreed to Club K's Family Handbook Code of conduct [English] | [Spanish].

Consent

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