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Kids Are Special

Please fill out the following information to register your child for Kids Are Special.

Child's Name (First and Last): 

Date of Birth (mm/dd/yyyy): 

KAS Program Interest: 

Parent/Primary Guardian (First and Last Name): 

Street Address: 

City:     State:     Zip: 

Home Phone:     Cell Phone: 

Mother's Workplace:    Work Phone: 

Father's Workplace:     Work Phone: 

Other Emergency Contacts:

Name:   Relationship: 

                   Phone: 

Name:   Relationship: 

                   Phone: 

Medical Information: Please list/explain any allergies or other medical conditions we should be aware of. This information will be kept strictly confidential.



Comments:  Please give us any tips or insights that might help us know your child better.



Thank you for taking the time to register your child for Kids Are Special. Please click here to download our Parent Consent form. Please sign your form and bring it with you on the first day of Kids Are Special.

Clicking the button below will submit your form and someone will be in touch with you within 3 business days to confirm your registration.