We provide childcare for children 1-year old up to those who have completed 5th Grade. The registration deadline is June 1, 2019. AC Kids Registration 2019 Child’s Name* First Last Child's Age*Grade/Class Completed*Parent’s Name* First Last Email Address* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Mom's Cell PhoneDad's Cell PhoneEmergency Contact Name* First Last Emergency Contact Phone*MedicalList any medical condition which might hinder the child in outdoor physical activities.Allergies/MedicationsList any allergies or medications.Medical Doctor*Insurance Carrier*Insurance Policy #*Insurance Group #If you have a group number, list it below. If not, leave this field blank.Childcare Sessions*Please indicate the sessions your child will attend. Meals and snacks are provided, except dinner on Saturday. Children with special diets should bring their food. Wednesday 7:30 am - 9:00 pm Thursday 7:30 am - 9:00 pm Friday 7:30 am - 6:00 pm Saturday 7:30 am - 1:00 pm Parental Permission*I hereby give my permission for my child to participate in all activities that are a regular part of the AC childcare program. I also herby agree that the childcare staff may authorize the physician of its choice to provide emergency care for my child in the event that neither our family physician nor I can be contacted immediately. I AgreeParent/Legal Guardian Signature*NameThis field is for validation purposes and should be left unchanged.