March 11th 2010, 3:54 CST

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Fall-2009-Registration

Please use the form below to register your child for the Fall 2009 session. If your child is a returning participant you only need to fill out the 'Child Information' and 'Fall 2009 Program Information' sections. If any other information has changed please make those changes as well.

Please enclose your non-refundable registration fee (per child, per class) as a check or cash which applies towards the child's tuition. This deposit will guarantee your child's spot in class. Your can see how much you owe upon registration by visiting the Prices & Policies page.

Kultural Kids
320 S. Main St.
Suite C
Morton, IL 61550

Child Information
First Name:
Last Name:
Sex:
Date of Birth:
 
Parent/Guardian Information
Guardian 1 First Name:
Guardian 1 Last Name:

Guardian 2 First Name:

Guardian 2 Last Name:
 
Contact Information
Address:
City:
State:
Zip Code
Home Phone #:
Other Phone #:
Email Address:
 
Release Information
If there is anyone other than the parents/caregivers to whom the child may be released, please list them below.
First Name:
Last Name:
Phone #:
   
First Name:
Last Name:
Phone #:
 
Emergency Information
Please provide as much information as possible in this section so that emergencies can be taken care of properly.
Contact Name:
Phone #:
Child's Physician:
Phone #:
Hospital Name:
Other important information (Allergies, medications, etc.)
 
Fall 2009 Program Information
Please select the program/s you want your child to attend. If your child will be attending a twice a week Spanish program, please use the second box below to select the second day and time. Progam with asterisk are 4 weeks. The rest are 8 weeks. Please see our policies for dates.
Program 1:
Program 2 (Optional):
Program 3 (Optional):
   
Other Information
How did you hear about us?
   
  If you do not agree to the terms below please uncheck them.
 
Kultural Kids has permission to use photographs with my child in them for use in self promotion in both print and electronic form.
 
My child has permission to go outside for Fall 2009 class activities (two teachers will be present at all times while outside).
   

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