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Summer Kops 4 Kids Registration 2022

Welcome to the Summer 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.  Multiple children can be filled out on one survey if there are no medical concerns.  If a student has medical information, please fill out a survey for each child.  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 Summer Kops 4 Kids fee schedule can be viewed on our website.  Payments are due weekly the Friday before the week your child will attend.  An additional survey will also be required to be completed to inform the Director which days your child(ren) will be attending.  Please make all checks 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.  

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* 1. Child's First and Last Name

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* 2. Child's First and Last Name

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* 3. Child's First and Last Name

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* 4. Date of Birth

Date

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* 5. Date of Birth (Child 2)

Date

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* 6. Date of Birth (Child 3)

Date

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* 7. Address

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* 8. City, State, Zip

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* 9. Student Phone

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* 10. Parent/Guardian First and Last 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 will be attending Week 1

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* 15. Person(s) Responsible for Pick-Up

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* 16. Emergency Contact

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

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* 18. How would you describe your child's general health?

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* 19. Does your child have any allergies?

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* 20. If you answered yes to question 19, what is your child allergic to?

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* 21. Has your child ever had a severe allergic reaction which requires medication to be kept in school?

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

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* 23. Does your child have any special fears or anxieties?

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

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

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* 26. Physician Name

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* 27. Physician Phone Number

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* 28. 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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* 29. By clicking this box, I acknowledge that I have read the Kops 4 Kids Communicable Disease Policy, Discipline Policy, Release of Children Policy, Social Media Policy and Suspension/Expulsion Policy listed on the Totowa Education Foundation's portion of the Totowa School District's website.

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