Kids’ College Information form

Kids’ College Information form

"*" indicates required fields

Student Name*

Parent / Guardian information

This information will only be used to contact during Kids’ College.
Parent / Guardian Name*

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:
include phone number


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 understand Texarkana College is not responsible for any items (i.e. clothing or money) my child may bring to class.*
I have discussed/will discuss inappropriate behavior with my child and am aware inappropriate behavior will result in removal from the program.*
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.*
Animal Disclaimer: My kids may participate in activities involving live animals during Kids' College.

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.
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
This field is for validation purposes and should be left unchanged.