After Care Registration Form

Emergency Card Information

All Information is Confidential

Parent/Guardian Information 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Area CodePhone Number

Parent/Guardian Information (2)

If same as above please provide cell number and email address.

Area CodePhone Number

Emergency Information

Area CodePhone Number

Persons Authorized to Pick Up Child other than Mother, Father/legal guardian:

Area CodePhone Number

Student Health History

All Information is Confidential

IMMUNIZATION INFORMATION

For students who reside within the United States, United States Territory or the District of Columbia:

For students who reside outside the United States, United States territory, or the District of Columbia:

2. Attach Department form DHMH-896 (Record of vaccination or immunity)

It is very important the parent/legal guardian keep all information on this sheet current at all times. It is also important that you inform emergency contacts who we are and you have placed their name on the Emergency Card.

Transportation Waiver

Read in Full Before Signing

I, parent/legal guardian authorize Kang's After Care to transport my son/daughter from their home school to the Kang's After Care Program. I, parent/legal guardian understand that other stops at local schools may be required during before reaching the desired location.

If for some reason I/ parent/legal guardian decide not to have Kang's After Care transport my child from their home school to the After Care program, I, parent/legal guardian must notify Kang's After Care Program and the home school of my decision by calling or texting Kang's at 301-598-1221. I, the parent/legal guardian would be responsible for arranging for my childs transportation from their home school.

Once the van has left the home school we will not do return trips to pick up students that have missed the van. Please be sure your child understands to be at the designated area for pick-up by the van each day. Parent's will be responsible for providing another means of transportation for the day your child has missed the van. Our driver will check with the person in charge of dismismal at the school but we do not have the time to stay for a long period of time since we do have to make other stops. Refunds will not be given for students that have missed the van and did not attend for that day.