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Select Page

Early Childhood Academy (Pre-K) Application 2022-2023

Register your rising Pre-K students by completing this form.

This application is for the Full Day Pre-K for 4-year-olds only.

Uh Oh! Your child is not eligible for the Early Childhood Academy this year.

If your child is 3 by August 15, 2023? They may be eligible for Summer Camp, and the 2023-2024 school year.
Parent's Contact Information
Child's Name
MM slash DD slash YYYY

CHILD'S INFORMATION

Provide information about your child. Please check to ensure accuracy!
Student's Name(Required)
Date of Birth:(Required)
Please enter a number from 1 to 7.
Gender:(Required)
Race(s) & Ethnicity:(Required)
Are you enrolling a second child?
Student's #2's Name:(Required)
Student's #2's Date of Birth:(Required)
Please enter a number from 4 to 19.
Student's #2's Gender:(Required)
Student's #2's Race(s) & Ethnicity:(Required)
Are you enrolling a third child?
Student's #3's Name:(Required)
Student's #3's Date of Birth:(Required)
Please enter a number from 4 to 19.
Student's #3's Gender:(Required)
Student's #3's Race(s) & Ethnicity:(Required)

Knowledge Quest History

Please provide details about the child and the child's family's previous experiences with KQ programming.
Home Address:(Required)

Parent or Guardian Information

Provide information for the primary caregiver for this child.
Guardian Name:(Required)
Is this person completing the form?(Required)
If no, who is?
Guardian Address(Required)

Contact Information

If no, who is the child's Legal Guardian?(Required)

Parent Guardian Additional Information

Please provide demographic information about the parent/guardian listed above.
Employment Status:(Required)
Work Address (Optional)

Parent/Guardian Information #2

Optional: contact information for a second parent or guardian.
Parent/Guardian Name:(Required)
Address(Required)
Employment Status:(Required)
School Information Consent(Required)
Knowledge Quest has my permission to obtain records and access to other educational information from the school where my child attends, as indicated above.

Household Information

Please provide accurate demographic information about the household. This information is for data purposes and will not be shared.
Type of Residence(Required)

Rehousing or Homelessness in past 18 months?(Required)
Please enter a number from 1 to 15.
Please enter a number from 1 to 15.
Members of Household(Required)
Select the family members who currently live with this child.
Please enter a number from 0 to 15.
Please enter a number from 0 to 15.
Please enter a number from 0 to 15.
Please enter a number from 0 to 15.
Please enter a number from 0 to 15.
Please enter a number from 0 to 15.
List all siblings. Add row for each new sibling.(Required)
First Name
Last Name
Birthday (mm/dd/yyyy)
 
Have utilities been disconnected in the past 18 months?(Required)

Student's Medical Information

It is the responsibility of the Parent or Guardian to provide Knowledge Quest with specific emergency procedures.
Are there any medical conditions or specifications? (allergies, medical issues, food requirements, etc.)(Required)
If yes, list conditions/concerns. Add a new row for each.
Does participant have a regular Primary Physician or Pediatrician?(Required)
Name of Physician:(Required)
Emergency Treatment Authorization(Required)
By checking this box, I am indicating consent and authorizing Knowledge Quest to provide first aid and/or to secure medical care in the case of an emergency for the child named on this application. I authorize the physician or hospital I provided in this section to treat my child in the event of an emergency. If this physician or hospital is not available or cannot be reached, I consent to care and treatment being administered by another licensed physician or treatment facility. I realize that I will be responsible for any costs of treatment. I will not hold Knowledge Quest or any of its staff or affiliates liable.

Child Relase Form

Acknowledgement of Consent(Required)
I give consent for the individuals I've indicated on this application under "Approved for Release" can sign my child in and out of KQ programming. I acknowledge Knowledge Quest will not be responsible for my child when they leave the program.

I agree to not hold Knowledge Quest, its employees, board of directors, and/affiliates harmless of any such claim, demand, cause of action, or any legal or equitable action arising out of relating to your child/children in the said release. As parent/legal guardian. I waive any rights to litigation regarding accident, injury, and/or expiry after my child has been dismissed from Knowledge Quest.
List those Authorized for Pick Up (add row for each):(Required)
First Name
Last Name
Phone
Relationship
 

Emergency Contacts

Please provide contact information for at least one additional adult (other than parent/guardians listed above) to contact in case of emergency. Add additional lines for each contact you wish to add.
Additional Emergency Contact(s):(Required)
First Name
Last Name
Relationship
Phone
 
Add row for each

Consents & Authorization

Please read the statements below carefully.
Media Release(Required)
I grant permission to Knowledge Quest to use my child's image may be used by Knowledge Quest. This consent includes the purposes of promoting the Extended Learning Academy, Knowledge Quest, and other related programs in various material and forms of media.
Statement of Consent for Activities(Required)
I give my permission for the child named on this application to engage in all off and on campus learning, recreational, and field trip experiences provided through Knowledge Quest programming during and after standard operation hours.

I agree to release Knowledge Quest, its employees, and affiliates from liability for injuries or loss of life resulting from or occurring during these activities as a result of regular program operations.
Statement of Indemnification(Required)
I hereby release and hold harmless Knowledge Quest, its employees, board of directors, and/or affiliates from any liability which may arise out of or in connection with my child/children's traveling as a part of Knowledge Quest, including, but not limited to potential claims, demands and causes or action for compensatory or punitive damages, attorney fees, costs, and other legal or equitable relief of any other legal or equitable relief of any kind, for injuries and damages, and the consequences thereof, whether known or unknown, foreseen or unforeseen, arising out of or resulting from Knowledge Quest, its staff, its affiliates or representatives.

I further agree to indemnify and hold Knowledge Quest, its employees, board of directors, and/or affiliates harmless of any such claim, demand, cause of action or any legal or equitable action arising out of relating to my child(ren) in said event. As parent/legal guardian, I waive any rights to litigation regarding accident, injury, and/or expiry through my child's participation in the program.
Statement of Confirmation(Required)
By checking this box I am confirming that I have completed this application to the best of my ability in all honesty. I am the parent/legal guardian of the child listed above. I give my permission for his/her participation in Knowledge Quest programming.
Documentation requirements listed below
The following documents will be required for the final step in the enrollment process: Parent's Photo Identification Parent's Proof of Income (3 most recent check stubs, 2021 W-2/Tax Return, Proof of Families First, SSI Disability or Child Support if Applicable) and proof of income for all adult members of the household 2 Documents for Parent's Proof of Address (MLGW Bill, Telephone Bill, Lease, or Mortgage in Parent's Name) Certified Copy of Child's Birth Certificate Certificate of Child's Immunization with Current Physical Exam (Within the past 12 months) Child's Health Insurance Card Child's Social Security Card Copy of IEP (If applicable) **Child must be present to be screened during the enrollment process If you have any questions, please call (901) 207-3694

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