CK ENROLLMENT

CIRCUL KID ENROLLMENT FORM

Parent information

* Indicates required field

Parents Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Student information

Name *

First

Last

Age *

Date of birth *

Gender *

Male Female

Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe. *

Sibling to other CIRCUL KID/s? *

YES NO

Grade *

Is the child prescribed an inhaler or any medical device? If yes, please explain any instructions. *

Any behavior issues we should be aware of? *

Emergency Contact information

Name *

First

Last

Phone Number *

Relationship to child *

Email *

List any other person allowed to pick up or receive information regarding child *

Important infORMATION

Do you agree to have read our Informed Consent and Acknowledgement *

YES NO

DO YOU AGREE TO FOLLOW ALL RULES OUTLINED IN THE PARTICIANT HANDBOOK. *

YES NO

SUBMITTING A Enrollment FORM DOES NOT GRANT ACCESS INTO the CIRCUL KIDS PROGRAM
PLEASE SEE "FINISH ENROLLMENT" BELOW ONCE YOU'VE CLICKED THE SUBMIT BUTTON

Submit

FINISH REGISTRATION

ONCE YOU SUBMITED YOUR REGISTRATION FORM:

PAY REGISTRATION FEES USING ONE OF THE OPTIONS BELOW
COMPLETE THE LIABILITY FORM AND BRING TO YOUR 1st MEETING
CONFIRMATION EMAIL WILL BE RECIEVED NO LATER THAN 48 HOURS AFTER BOTH REGISTRATIOIN FORM AND FEES HAVE BEEN RECIEVED

Payment

Please pick a payment method. Include Childs name in payment notes

Paypal

VENMO

DOCUMENTS

Click below to view all important information and documents

Forms/Docs