Student Name (Nombre del Estudiante) *

First Name

Last Name

Date of Birth (Fecha de Nacimiento) *

MM

DD

YYYY

My child is in... (Mi hijo/a esta en...) *

Pre-K (Pre-Kinder)

Elementary (Primaria)

Parent/Guardian Name (1) *

First Name

Last Name

Emergency Phone No. *

(###)

###

####

Parent/Gaurdian Name (2)

Optional

First Name

Last Name

Alternate Emergency Phone No.

(###)

###

####

I give Miss Kim's Educational Center permission to share pictures of my child on misskims.org, Google Classroom, and/or the school’s private Instagram account.

Yes

No

On Tuesdays, I would prefer my child to attend: *

Virtually

On Campus

On Wednesdays, I would prefer my child to attend: *

Virtually

On Campus

On Thursdays, I would prefer my child to attend: *

Virtually

On Campus

Sign up for Pre-K Plus *

I understand that I am contractually obligated to pay $15.00/class for Pre-K Plus. This payment covers the cost of both the standard 30-min. Pre-K class and the additional 30-min. Pre-K Plus class. The "Notice of Change" clause applies to this add-on; therefore, I agree to provide a two-weeks paid notice prior to withdrawing my child from the Foreign Language Class.

Yes, sign my child up for Pre-K Plus

No, we are only interested in the standard 30-min. Pre-K class at this time

Not applicable, my child is not in Pre-K.

(+) Sign up for Summer 2021 Tutoring Sessions (on Mondays) *

I understand that I am contractually obligated to make a weekly payment of $20.00 (for a Grand Total of: $160.00) per child for eight Summer 2021 Tutoring sessions.

Yes, sign my child up for Summer 2021 Tutoring.

No, my child will not require Summer 2021 Tutoring.

(+) Sign up for Foreign Language Classes *

I understand that I am contractually obligated to make an additional payment of $5.00/student/30-min. session during the Summer 2021 Session. During the Summer 2021 Session, I am committed to the days I have selected during the eight week period. Note: Private classes are available upon request, please contact Miss Kim for more information.

Spanish

French

We are not interested in Foreign Language at this time.