2023-24 Enrollment Form

Ketchikan Afterschool Program (KAP)

School Year '23'-'24 Enrollment Form
KAP is an island-wide indoor-outdoor program featuring various workshops with a strong focus on the arts, sports, and outdoor education.

Participation in the Ketchikan Afterschool Program is free. Students may enroll at any time, although some workshops may have required start dates. Students will be provided a healthy snack and a choice of activities.This enrollment form is required for your child to be able to participate in all of KAP's programs including attending our Plaza Location.

Student Information**
First Name*
Legal First Name
Last Name*
Legal Last Name
Gender*

MaleFemale
Birth Date*

MonthDayYear
Grade*
What grade will your youth be enrolled in for the '23-'24 School Year?
School*
What is the name of the school that your youth will attend in the '23-'24 school year?
Home Phone*

Area CodePhone Number
Has your child participated in previous KAP afterschool or summer programs?*
Does your child have any special needs or behavior concerns that require extra care and attention? If so, please explain.
Does your child have any allergies? If yes please list, including any food or drug allergies.
**All information is protected and expressly for the use within our program. We do not use this information for any other purpose than for permissions and contact information of Parents/Legal Guardians. No other individuals or organization will have access to this information.KAP is a state funded program and we do report statistical data as a requirement of our funding. This data does not include any personal information of any kind nor any information you provide on this form. We are happy to show you all the information we report upon request.
Primary Parent/Guardian Information
Full Name*

First NameLast Name
Home/Cell*

Area CodePhone Number
Work

Area CodePhone Number
E-mail*
Would you be interested in volunteering, chaperoning, or leading a youth project?

YesMaybeNo
Emergency Contact

(Must be other than Parent/Guardian)
Full Name*

First NameLast Name
Relation:
Home/Cell*

Area CodePhone Number
Work

Area CodePhone Number
Permissions
Photo Release: I understand KAP will take photos of activities for the sole purpose to promote the program. I understand my child may appear in a photo KAP uses on it's website, flyers and other promotional materials.

I understand
Survey Requirement: KAP will survey my child anonymously for the purpose of improving the program and tracking our growth. I understand that I can view the survey questions upon request anytime.*

I understand
KAP Activity AND Transportation Waiver*

I agree
Paper Version
Signature*

Clear
Bouldering Waiver

This is optional. Only participants with a waiver on file may use the bouldering wall. Please read and sign below to give your child permission to use our bouldering wall.
I have read the Bouldering Waiver

I agreeMy child will not participate in bouldering at any time.
Climber's Name

First NameLast Name
Climber's Birth Date

MonthDayYear
Date
Signature of Parent/Legal Guardian for Bouldering waiver

Clear
Comments? Concerns? Questions?
PRESS SUBMIT

press "SUBMIT' button below.
Thank You for Your Interest in the Ketchikan Afterschool Program!

Contact Information:

(907) 202-5404

kap@rycalaska.com

Ketchikan Afterschool Program
2417 Tongass Ave
STE# 203
Ketchikan, Alaska 99901
Should be Empty:

Ketchikan Afterschool Program (KAP)

Student Information**

Primary Parent/Guardian Information

Emergency Contact

Permissions

Bouldering Waiver

PRESS SUBMIT