2022-2023 NMCSC Charger KidZone (CKZ)

Enrollment Form

Child #1

 +
Who has legal custody of this child?

(Please remember to provide a copy of any custody agreement/decree - if applicable)

 *
 

Schedule

 +
 +
Select Weekly Tuition Schedule

(see Parent Handbook for information on monthly tuition plans)

 *
Days of the Week *

Individual Education Plan (IEP)

Does your child have an IEP? *

Medical Information

Does your child have a diagnosed condition or special needs? *
If yes, check all that apply and submit a Plan of Care Form with your enrollment paperwork.

Once you have chosen the condition(s) that applies, you may click the link for the Plan of Care Form. Please complete the form, print, sign, and turn into the Central Office.

 
Are there any modifications or accommodations that would be beneficial to your child? *
Does your child take regular medication? *
If yes and medication is to be dispensed while at NMCSC CKZ, please submit a completed Medication Consent Form when you drop off the medication on the child's first day.  Medication must be in the original bottle with the label attached.

Child #2

 +
Who has legal custody of this child?

(Please remember to provide a copy of any custody agreement/decree - if applicable)

 

Schedule

 +
 +
Select Weekly Tuition Schedule

(see Parent Handbook for information on monthly tuition plans)

Days of the Week

Individual Education Plan (IEP)

Does your child have an IEP?

Medical Information

Does your child have a diagnosed condition or special needs?
If yes, check all that apply and submit a Plan of Care Form with your enrollment paperwork.

Once you have chosen the condition(s) that applies, you may click the link for the Plan of Care Form. Please complete the form, print, sign, and turn into the Central Office.

 
Are there any modifications or accommodations that would be beneficial to your child?
Does your child take regular medication?
If yes and medication is to be dispensed while at NMCSC CKZ, please submit a completed Medication Consent Form when you drop off the medication on the child's first day.  Medication must be in the original bottle with the label attached.

Child #3

 +
Who has legal custody of this child?

(Please remember to provide a copy of any custody agreement/decree - if applicable)

 

Schedule

 +
 +
Select Weekly Tuition Schedule

(see Parent Handbook for information on monthly tuition plans)

Days of the Week

Individual Education Plan (IEP)

Does your child have an IEP?

Medical Information

Does your child have a diagnosed condition or special needs?
If yes, check all that apply and submit a Plan of Care Form with your enrollment paperwork.

Once you have chosen the condition(s) that applies, you may click the link for the Plan of Care Form. Please complete the form, print, sign, and turn into the Central Office.

 
Are there any modifications or accommodations that would be beneficial to your child?
Does your child take regular medication?
If yes and medication is to be dispensed while at NMCSC CKZ, please submit a completed Medication Consent Form when you drop off the medication on the child's first day.  Medication must be in the original bottle with the label attached.

Child #4

 +
Who has legal custody of this child?

(Please remember to provide a copy of any custody agreement/decree - if applicable)

 

Schedule

 +
 +
Select Weekly Tuition Schedule

(see Parent Handbook for information on monthly tuition plans)

Days of the Week

Individual Education Plan (IEP)

Does your child have an IEP?

Medical Information

Does your child have a diagnosed condition or special needs?
If yes, check all that apply and submit a Plan of Care Form with your enrollment paperwork.

Once you have chosen the condition(s) that applies, you may click the link for the Plan of Care Form. Please complete the form, print, sign, and turn into the Central Office.

 
Are there any modifications or accommodations that would be beneficial to your child?
Does your child take regular medication?
If yes and medication is to be dispensed while at NMCSC CKZ, please submit a completed Medication Consent Form when you drop off the medication on the child's first day.  Medication must be in the original bottle with the label attached.

Parent/Guardian #1

Check all that apply: *
Employee of NMCSC: *

Parent/Guardian #2

Check all that apply:
Employee of NMCSC:

Additional Emergency Contacts & Authorized Pick-Up

Please note for authorized pick-up: must be 18 years or older and ID required!
 Contact #1Contact #2Contact #3
Name
Relationship to child
Cell Phone