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C-Clubs Registration

C-Clubs Registration Form

Name:
Date of Birth:
Grade:
Address:
Apt.#:
City:
State:
Zip:
Email:
Phone:
Parent(s) Name:
Cell:
Emergency Contact:
Phone:
In extreme emergency, when I cannot be reached, I prefer my child to be transported to  for emergency care.
Health Plan:
Plan No:
Subscriber's Name:
Subscriber's ID No:
Please list any medical needs, allergies, or medication: 

 
    
Child Protection Policy 

As we develop new procedures to improve our Child Security and Protection Policy, we want to keep you informed and request your assistance.  To insure the protection of your children, we are instituting the following procedures:


  •  There will only be one entrance used to drop off and pick up your children.  This will be the ground-level entrance at the north side of the building.
  • You must accompany your children into the building at this entrance, remain inside the designated area and sign your child in at the “Security Desk”.  Please plan to arrive by 6:45 pm.  The opening begins promptly at 7:00 pm. in the auditorium.
  • Pick-up your children by entering the building through the same entrance and sign-out your child.  Your initials in the boxes adjacent to your child’s name will accomplish the sign-in/sign-out processes.  

I have read and agree to follow the Child Protection Policy. 

3583 NJ-27 • Franklin Park, NJ 08823

info@kpbc.net • 732.297.4644