Easy registration So many options: Online
• By Phone By Fax • By Mail • In Person
Online - www.priorlakesavagece.com • Phone - 952-226-0080 • Fax -952-226-0099 By Mail or In Person- ISD 719 Community Education, 4540 Tower St SE, Prior Lake, MN 55372
Youth Registration Form
Child’s Name_ __________________________________ Birthdate_ _____________ Grade 2012-13________ Child’s Name_ __________________________________ Birthdate_ _____________ Grade 2012-13________ Child’s Name_ __________________________________ Birthdate_ _____________ Grade 2012-13________ Parent/Guardian_______________________________________ Typical After School Routine □ Bus □ Pickup □ Kids’ Co □ Other_______________________________________ School____________________________________ Bus #______ Teacher’s Name_ ___________________ Home Phone_________________________ Daytime/Cell_________________________ Address_____________________________________________ City_ _______________ Zip____________ Email Address for Confirmation_____________________________ I have read and agree to the Community Education Class Safety/Behavior Procedures (listed below). Signature____________________________________________ Date______________ Person picking child up other than parent_______________________________________________________ Does your child have any medical or other related conditions that the instructors should be aware of? ___________________________________________________________________________________ Child
____________ _________ _ ___________________ _ ______________ ________ ____________ _________ _ ___________________ _ ______________ ________ ____________ _________ _ ___________________ _ ______________ ________ Visa/Mastercard/Discover Account #_________________________ Exp. Date:__________ Class Safety and Behavior Procedures - Help us ensure the safety of your child!
• Provide an accessible daytime phone number and an additional emergency contact when registering your child for programs. • For After School Classes, please include your child’s teacher’s name, your child’s typical after school routine, and bus number if applicable. • Please notify the Community Education Office at 952.226.0080 as soon as possible if your child will not be attending a session of a class for which they are registered. • If someone other than a parent will be picking up your child from class, please let the instructor and/or a Community Education staff person know ahead of time. • Drop off your child in the classroom on time each session. • Elementary After School CE Participants will be dismissed from their elementary classroom to Kids’ Company (KC) Staff. Students will eat snack (provided by CE) with KC. CE class instructors will pick up registered class participants from Kids’ Company. • Pick up your child in the classroom at the class ending time. If you cannot pick up on time, you are expected to make other arrangements for your child ahead of time. Late pickups are subject to a fee. • Inform the instructor AND a Community Education staff person of any allergies, special needs, or behavioral concerns that may help us to provide the best environment and instruction for your child and the other students enrolled. • The behavior of students is expected to be appropriate for the class learning environment. The instructor and Community Education staff reserve the right to dismiss students immediately, without a refund, when behavior is not appropriate or jeopardizes the safety of them or other students. Should this become necessary, parents will be contacted and expected to pick up children immediately. Please Note: These procedures have been modified for Winter 2013.
Visit www.priorlakesavagece.com or call 952-226-0080