"*" indicates required fields

Student Name*

First Last

Parent / Guardian information

This information will only be used to contact during Kids' College.

Parent / Guardian Name*

First Last

Emergency Phone*

Work Phone

Cell Phone

Emergency information

If I cannot be reached to make plans for emergency care for my child, I give my permissions for Texarkana College to take my child to:

Hospital*

Doctor

include phone number

Child's known allergies or significant medical history:

Agreements

I understand photos may be taken for marketing purposes. Should I opt my child out, I understand it is my responsibility to make staff aware of my request in writing.

I agree

I understand Texarkana College is not responsible for any items (i.e. clothing or money) my child may bring to class.*

I agree

I have discussed/will discuss inappropriate behavior with my child and am aware inappropriate behavior will result in removal from the program.*

I agree

I understand that in the event of thunder and lighting, I will be required to come into the Truman Arnold Student Center to pick up my child.*

I agree

Animal Disclaimer: My kids may participate in activities involving live animals during Kids' College.

I agree

Release of Liability Statement

I state that I assume full responsibility for any accident or personal injury that might befall my child due to participation in Kids’ College activities. I assume this responsibility with full acceptance of the risks, known and unknown to me at this time. I further state that my child has no known health problems, conditions, or concerns which may preclude them from safe participation in a classroom/physical activity program, and agree to inform the instructor of any minor concerns which may develop. I give permission for my child to be transported by Texarkana College faculty, staff, or volunteers to and from the location of their related Kids’ College activity. I hereby hold harmless and release Texarkana College from all liability arising out of any injury, loss, claim, or damage which may be sustained by my child due to participation in Kids’ College activities.

I state that I have read this document, agree with its terms, and I am signing this contract voluntarily.*

Type name & relation to child

Pick-up information

List 3 names as options to pick up children*

These will be the only ones allowed to pick up child

Kids’ College Information form

Kids’ College Information form

Parent / Guardian information

Emergency information

Agreements

Release of Liability Statement

Pick-up information

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