Register for Kingdom Kids/Young Pioneers (4 1/2-6 yrs)

ALL CLASSES ARE CURRENTLY FULL; HOWEVER, PLEASE FEEL FREE TO CONTINUE THE REGISTRATION PROCESS & SELECT THE “WAITLIST” OPTION FOR YOUR PREFERRED CLASS(ES). Please do NOT pay the registration fee until you are notified that your child has a confirmed place in class.

Student's name *
Student's name
Student's birthday *
Student's birthday
Mother's name *
Mother's name
Mother's cell phone *
Mother's cell phone
Father's name
Father's name
Father's cell phone
Father's cell phone
Home address
Home address
Emergency contact *
Emergency contact
Emergency contact phone *
Emergency contact phone
I agree to submit the $25.00 registration fee with this form and understand that my child will not be enrolled until this payment is received. I agree to pay the full semester tuition, due and payable in full on or before the first day of class or I must submit a Charter School PO/voucher on or before the first day of classes. I understand that I am liable to pay any amount not covered by my charter school. *
I hereby solely and expressly assume liability for all risks and waive any claim I might have against Amy Sachs or individuals acting in the capacity as agents of the organization (staff members, independent contractors, volunteers, etc.). I assume full legal liability for my child’s actions in class and release Amy Sachs and agents acting on behalf of Amy Sachs from any claims made as a result of my actions. This release shall be effective and binding upon the parties, as well as their heirs, beneficiaries, assigns, successors and legal representatives. By checking the box, I acknowledge having read and understood this release. *
By entering your name below, you agree to the conditions set forth in this form.
Today's date *
Today's date