Skip to content
find the location nearest you
Facebook
Instagram
We Are Hiring!
Register Now
find the location nearest you
Facebook
Instagram
We Are Hiring!
Inquire Now
Register Now
find the location nearest you
We Are Hiring!
Register Now
Home
Services
After School Care
Holidays and Breaks
Digital Connections
Summer Camp
About
About us
Careers
Social-Emotional Success Plans
Why Choose Us
Covid-19 Safety Measures
Careers
Locations
ALOHA – HUBER PARK
BOECKMAN CREEK
BOONES FERRY
BRIDGEPORT
BYROM
DURHAM
LOWRIE
MARY WOODWARD
MCKINLEY
MITCH
NANCY RYLES
OAK HILLS
RALEIGH HILLS
ROCK CREEK
SCHOLLS HEIGHTS
ST. IGNATIUS
TERRA LINDA
VOSE
Parent Corner
Contact Us
X
Home
Services
After School Care
Holidays and Breaks
Summer Camp
About
About us
Social-Emotional Success Plans
Why Choose Us
Health and Safety
TUITION SUPPORT
Careers
Locations
DURHAM
BRIDGEPORT
MITCH
MARY WOODWARD
OAK HILLS
NANCY RYLES
BYROM
BOECKMAN CREEK
ROCK CREEK
SCHOLLS HEIGHTS
TERRA LINDA
VOSE
ALOHA - HUBER PARK
ART RUTKIN
BOECKMAN CREEK
Boones Ferry
BRIDGEPORT
BYROM
DURHAM
MARY WOODWARD
MITCH
NANCY RYLES
OAK HILLS
SCHOLLS HEIGHTS
ST. IGNATIUS
TERRA LINDA
TUALATIN
VOSE
Parent Corner
Contact Us
X
New Families Fall Registration Form 2019-2020
Primary Account Person
First Name
*
M.I.
Last Name
*
Relationship to Child
*
Gender
Male
Female
Current School Child(ren) Attends
*
McKinley Elementary
Rock Creek Elementary
Oak Hills Elementary
Scholls Heights Elementary
Terra Linda Elementary
Vose Elementary
Boeckman Creek Primary
Boones Ferry Primary
Lowrie Primary
Bridgeport Elementary
Byrom Elementary
Durham Elementary
Mary Woodward Elementary
Address
Street Address
*
City
*
State
*
Zip Code
*
Mailing Type
*
Physical
Mailing
Phone Number (no dashes or spaces required)
Phone Number
*
Account Questions
Preferred Email Address
*
Parent Place of Employment
*
What are your child(ren)'s current interests?
What are your goals for your child from their after school experience?
Do you as a parent have any special skills or talents that may be of interest or shared with the children in our program?
Promo Code
How did you hear about Club K?
*
Friend/Referral
Online Search
Website
Kidsfest
School Office
Facebook
Yelp
Family Fest Expo
PDXParent
What is your preferred start date? Please note - Registration can take up to 10 days during high volume times.
I plan on paying my tuition by
*
Subsidy
Scholarship
Splitting my bill with _____ (Please put their name in the note section below)
Covering the tuition myself
Notes
1st Child's information (Click arrow to enter information) >>>
First Name
*
M.I.
Last Name
*
Gender
*
Male
Female
Date of Birth
*
Enrollment
*
School Year 2019-2020
Grade level for the 2019-2020 school year?
*
Kinder
1st
2nd
3rd
4th
5th
6th
7th
T Shirt Size (Youth)
T-Shirt Small
T-Shirt Medium
T-Shirt Large
T-Shirt XLarge
Does your child have any of the following?
*
Non Life Threatening Allergies
Life Threatening Allergies
Custody Order, Court Order, or Parenting Plan (must provide copy prior to enrolling)
Medical Conditions
IEP or 504 Plan (must provide copy prior to enrolling)
None of the above
Please list any allergies your child has. indicate if any are life threatening.
Please list any medical conditions your child has.
Doctors name and phone number
*
Insurance Carrier / ID Number / Group Number
*
Package 19/20
*
Silver (Regular School Days)
Drop In Care (Subject to space availability)
Days Attending
*
Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Friday AM
Friday PM
Drop In by Request
2nd Child's information (Click arrow to enter information) >>>
First Name
M.I.
Last Name
Gender
Male
Female
Date of Birth
Enrollement
School Year 2019-2020
Grade level for the 2019-2020 school year?
Kinder
1st
2nd
3rd
4th
5th
6th
7th
T Shirt Size (Youth)
T-Shirt Small
T-Shirt Medium
T-Shirt Large
T-Shirt XLarge
Does your child have any of the following?
Non Life Threatening Allergies
Life Threatening Allergies
Custody Order, Court Order, or Parenting Plan (must provide copy prior to enrolling)
Medical Conditions
IEP or 504 Plan (must provide copy prior to enrolling)
None of the above
Please list any allergies your child has. indicate if any are life threatening.
Please list any medical conditions your child has.
Doctors name and phone number
Insurance Carrier / ID Number / Group Number
Package 19-20
Silver (Regular School Days)
Drop In Care (Subject to space availability)
Days Attending
Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Friday AM
Friday PM
Drop In by Request
3rd Child's information (Click arrow to enter information) >>>
First Name
M.I.
Last Name
Gender
Male
Female
Date of Birth
Enrollement
School Year 2019-2020
Grade level for the 2019-2020 school year?
Kinder
1st
2nd
3rd
4th
5th
6th
7th
T Shirt Size (Youth)
T-Shirt Small
T-Shirt Medium
T-Shirt Large
T-Shirt XLarge
Does your child have any of the following?
Non Life Threatening Allergies
Life Threatening Allergies
Custody Order, Court Order, or Parenting Plan (must provide copy prior to enrolling)
Medical Conditions
IEP or 504 Plan (must provide copy prior to enrolling)
None of the above
Please list any allergies your child has. indicate if any are life threatening.
Please list any medical conditions your child has.
Doctors name and phone number
Insurance Carrier / ID Number / Group Number
Package 19/20
Silver (Regular School Days)
Drop In Care (Subject to space availability)
Days Attending
Monday AM
Monday PM
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Friday AM
Friday PM
Drop In by Request
Emergency Contact Information (Must be at least 18 years old. Must be different than above)
Name
*
Phone Number
*
Relationship to Child
*
Name
*
Phone Number
*
Relationship to Child
*
If you are human, leave this field blank.
Submit
