Kids of the Kingdom Episcopal School

   Where Children Know They are Loved by God

Registration Packet For 2017-2018 School Year
AUGUST 14, 2017-JUNE 8, 2018

Date Registered: ____________________ Withdrawal Date: ________________


Student Information


Child’s Name: ____________________________, __________________________

(Last) (First)

Date of Birth: ___________ Age on September 1, 2017_____ Current Age: ______

Preferred Name: _____________________________ Sex: ___Male ___Female

Street Address: ___________________________________________________

City: _______________________ State: _____________Zip Code: __________

Best day-time contact: _______________________ Phone #:_________________

Name of siblings also attending KOKES: __________________________________


Religious Affiliation (Optional)


Religion: __________________ Place of Worship: ________________________

We are active members of ____The Episcopal Church of the Holy Spirit


Fall Program
 
 
 
Ages
Ages
 School Age Program
 Official Use Only
 Infants
 Part-Time 3's
 Before School
Tuition amount
 Toddlers
 Full-Time 3's
 After School
 
 Ones
 Part-Time 4's
 Grade______
 
 Twos
 Full-Time 4's
 
 
Start Date: __________________________ Hours of Attendance: ____________
Summer Learning Camp
 
 
 
Ages
 Ages
 School Age Campers
 Official Use Only
 Infants
 Part-Time 3's
 Part-Time__________
 Tuition Amount
 Toddlers
 Full-Time 3's
 Full-Time__________
 
 Ones
 Part-Time 4's
 Grade Going Into________
 
 Twos
 Full-Time 4's
 
 

Start Date: _________________________ Hours of Attendance: _____________



Signature (Parent or Legal Guardian) ______________________________________________Date:_______________



Parent 1 / Guardian Information

This should be the person we should contact first


Last Name: _____________________________ First Name: __________________

Address if different from child’s address:

Street: _____________________________City:__________________Zip________

Phone number while child is in care: _____________________

Home Phone Number: ___________________

Work Phone: ________________________

Primary E-mail:___________________________________

Employer: ________________________ Title: _____________________________



Parent 2/ Guardian Information


Last Name: _____________________________ First Name: __________________

Address if different from child’s address:

Street: ____________________________ City: __________________ Zip________

Phone number while child is in care: _____________________

Home Phone Number: ___________________

Work Phone: ___________________________

Primary E-mail:___________________________________

Employer: ________________________ Title: _____________________________


Household Arrangement

Child lives with:

___Both parents ___Father___ Mother ___Legal Guardian ___ Stepfather ___ Stepmother


Check if appropriate:

___ Parents married ___ Parents separated ___ Parents divorced

___ Mother deceased ___ Father deceased

___ Mother remarried ___ Father remarried


If parents are divorced or separated, should both parents receive correspondence?

___yes ___no


Signature (Parent or Guardian)
_____________________________________________________Date:__________________



AUTHORIZATIONS


CHILD’S NAME

Emergency Medical Attention

In case of emergency if parents/guardian cannot be reached please contact:

Name: _____________________________________________________Phone:____________________

Address: ________________________________City_______________Zip:________________________ Relationship:____________________________


In the event that the parents/guardian or emergency contact cannot be reached to make arrangements for emergency medical care, I give consent for KOKES to secure any and all necessary emergency care for my child.


Signature of Parent or Legal Guardian: ______________________________________________________


Emergency Medical Care Facility:

Methodist Children’s Hospital 7700 Floyd Curl Dr. San Antonio, TX 78229

Phone: 210-575-7000

Name of Physician: _____________________________________________________________________

Address: _____________________________________________ Phone: __________________________


Allergies etc.: List any special problems that your child may have, such as food allergies, allergies, existing illness, previous serious illness, injuries and hospitalizations during the past 12 months, any medication prescribed for long-term use, disabilities, special needs and any other information which caregivers should be aware of:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________  NO ALLERGIES________PLEASE INITIAL


Authorization for the Release

Children will only be released to a parent or person designated by the parent/guardian after verification of picture ID. I hereby authorize Kids of the Kingdom Episcopal School to allow my child to leave KOKES ONLY with the following persons: (The Parent/Guardian do not need to be listed here.)

Name: ______________________________________________ Phone: ___________________

Name: ______________________________________________ Phone: ___________________

Name: ______________________________________________ Phone: ___________________


Please check yes or no

I understand that children in the full-time program will be served breakfast (7:30-7:50), lunch and am/pm snack. Children in the Part-time program will receive a morning snack and lunch. School age children will receive breakfast (If they are registered for before school care.) and an afternoon snack. Yes___ No___

I give permission for my child to participate in splashing/wading pools and water play tables.

Yes ___ No___

I give permission for KOKES to post pictures of my child in marketing materials such as Face Book, Brochures, Website or other KOKES publications. Yes___ No___


Signature (Parent or Guardian): _________________________________________________Date: _______________


SCHOOL AGE ONLY

My child attends the following school: (please circle):

Wanke Elementary School 10419 Old Prue Rd San Antonio, TX 78249 (210) 397-6700

Steubing Elementary School 11655 Braefield San Antonio, TX 78249 (210) 397-4390

Other: _______________________________________________________________


CHECK ALL THAT APPLY

___His / her immunization record is on file at the school and all required immunizations and/or tuberculosis test are current. Vision and Hearing screenings are also on file.

Name of sibling(s) attending KOKES: _____________________________________


Signature (Parent or Guardian):_________________________________________________Date:________________