2022-23 Enrollment Form

KAP-Ketchikan Afterschool Program

Enrollmet FORM
Totally FREE

Details:

Island-wide indoor-outdoor program featuring various workshops with a strong focus on the arts, sports, and outdoor education.

This ENROLLMENT is required for your child to be able to participate in all of KAP's programs including attending our Plaza Location.

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 inforamtion you provide on this form. We are happy to show you all the information we report upon request.

About KAP: Participation in the Ketchikan Afterschool Program is free, or in some cases there will be scholarships available. 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.

If siblings are eligible, please fill out a separate form for each sibling. Thank you!

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

MaleFemale
Birth Date*

MonthDayYear
Home Phone*

Area CodePhone Number
Has your child participated in previous KAP afterschool or summer programs?*
is there a particular workshop that you are signing your youth up for? If so, please enter the name of that workshop here.
Does your child have any special needs or behavior concerns that require extra care and attention? If so, please explain in detail.
Please tell us about your child. Describe his or her interests, hobbies, extracurricular activities, and anything else that will help us get to know your child better.*
Youth School Information
Grade*
What grade will your youth be enrolled in for the 22-23 School Year?
School*
What is the name of the school that your youth will attend in the 22-23 school year?
Primary Parent/Guardian
Full Name*

First NameLast Name
Home*

Area CodePhone Number
Cell*

Area CodePhone Number
Work

Area CodePhone Number
E-mail*
Emergency Contact

Other than Parent/Guardian
Full Name*

First NameLast Name
Home*

Area CodePhone Number
Work

Area CodePhone Number
Cell*

Area CodePhone Number
Medical
Does your child have any allergies? If yes please list, including any food or drug allergies.
Your Expectations

KAP would like to support you in your decision to enroll your child in our Program.
Please share any expectation you have of our Program, any concerns or ideas.
Attendance Report: KAP can provide you with a weekly attendance report for your child. We will send it to the email you have provided.

Please Provide me with a weekly attendance report for my child.
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*

I understand Ketchikan Afterschool Program 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.
Would you be interested in volunteering, chaperoning, or leading a youth project?

YesMaybeNo
KAP Activity AND Transportation Waiver*

I agree
Paper Version
I request the program van to drop off my youth in the evenings (activities end at 5:30) due to the follow:

Lack of Access to a Vehicle at HomeParent/Guardian Works in the Evening
Signature*

Clear
Please scroll down to complete this form
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.
Climber's Name

First NameLast Name
Climber's Birth Date

MonthDayYear
Date
Signature of Parent/Legal Gardian for Bouldering waiver

Clear
PRESS SUBMIT

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

THANK YOU!!!

Contact Information:

Director: Andrew Eisenberg

andrewe@rycalaska.com

907-202-5404

www.ricorps.org

Ketchikan Afterschool Program
2417 Tongass Ave
STE# 203
Ketchikan, Alaska 99901
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