Kops 4 Kids & TPK Kops 4 Kids Registration 2021-2022

Welcome to the Kops 4 Kids and TPK Kops 4 Kids online registration forms.  Please be advised that all information requested below is the same as the brochures posted on the Totowa Education Foundation section of the Totowa Public Schools website.  Information requested below is required to be filled out in its entirety.  If an answer is not applicable please indicate so.  If you have any questions or concerns, do not hesitate to contact Linda Paese at 973-956-0010 ext 6002.  

The Kops 4 Kids and TPK Kops 4 Kids fee schedules can be viewed on our website, totowa.k12.nj.us, under the Totowa Education Foundation link then the Kops 4 Kids link and then the Kops 4 Kids or TPK Kops 4 Kids brochures.  Multiple students can be enrolled on one survey, however, if a student has a medical concern please indicate which student or students have the concern in the explanation box under the question.  Payments for September are due the first day of Kops 4 Kids and all payments thereafter are due the 1st of the month.  Please make all checks or money orders payable to the Totowa Education Foundation.  Cash will not be accepted.  

Please note that children will only be released to the names indicated in the Person(s) responsible for pick-up section of this form.  

Misrepresenting or omitting pertinent information from the enrollment form or the health history are grounds for expulsion.

The Totowa Education Foundation does not provide health insurance coverage for students.  It is highly recommended that the Parent/Guardian obtain health insurance coverage for their child(ren).

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* 1. Child 1's Name

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* 2. Child 2's Name

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* 3. Child 3's Name

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* 4. Child 1's Date of Birth

Date

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* 5. Child 2's Date of Birth

Date

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* 6. Child 3's Date of Birth

Date

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* 7. Address

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* 8. City, State, Zip

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* 9. Child's Phone

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* 10. Parent/Guardian Name

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* 11. Parent/Guardian Phone

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* 12. Parent/Guardian Work Phone

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* 13. Parent/Guardian Email

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* 14. Please indicate the days your child(ren) will be attending K4K

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* 15. Please indicate the session your child(ren) will be attending K4K

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* 16. Please indicate person responsible for pick up with phone number

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* 17. Emergency Contact

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* 18. By clicking this authorization box, I acknowledge that I am responsible for the tuition payment and fees as stated in the K4K and/or TPK K4K brochures and will adhere to the payment schedule and conditions set forth within the K4K and/or TPK K4K brochures.

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* 19. How would you describe your child(ren)'s general health?

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* 20. Does your child(ren) have any allergies?

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* 21. If you answered yes to question 17, what is your child allergic to?

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* 22. Has your child(ren) ever had a severe allergic reaction which requires medication be kept in school?

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* 23. If you answered yes to question 19, please explain.

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* 24. Does your child(ren) have any special fears or anxieties?

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* 25. If you answered yes to question 21, please explain.

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* 26. Is there any additional health/medical information about which we should be made aware of?

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* 27. Physician Name

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* 28. Physician Phone Number

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* 29. In the event that medical treatment is necessary, it should be understood that if a parent or guardian does not sign this statement, treatment may not be rendered.  I hereby authorize the Totowa Education Foundation and its faculty members in charge of my child to obtain all necessary medical care and further authorize any licensed physician and/or medical personnel to render all necessary medical treatment.

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