Child 1 Grade

Child 1 School

Child 1 Allergies, Medications, and/or Dietary Restrictions

If your child has any allergies, please list them here and include severity, symptoms, and treatment. If they have important medical information or dietary restrictions, please list that here as well.

Child 1: Which program would your child like to try?

Child 1: Which date would your child like to join us for a sample day? If you have multiple dates that work for you, please enter them below. (We will do our best to accommodate your preferences.)

Child 1: If you are trying out our weekday afternoon program, will you need JKG transportation from your child's school that day? (If available.)

Child 1: If you selected “Yes, I need JKG transportation,” does your child require any of the following transportation needs when riding in a JKG vehicle? (Note that all students under the age of 8 are required by law to be in a booster seat or car seat.)

Child 2 Grade

Child 2 School

Child 2 Allergies, Medications, and/or Dietary Restrictions

If your child has any allergies, please list them here and include severity, symptoms, and treatment. If they have important medical information or dietary restrictions, please list that here as well.

Child 2: Which program would your child like to try?

Child 2: Which date would you like your child to join us for a sample day? If you have multiple dates that work for you, please enter them below. (We will do our best to accommodate your preferences.)

Child 2: If you are trying out our weekday afternoon program, will you need JKG transportation from your child's school that day? (If available.)

Child 2: If you selected “Yes, I need JKG transportation,” does your child require any of the following transportation needs when riding in a JKG vehicle? (Note that all students under the age of 8 are required by law to be in a booster seat or car seat.)

Parent/Guardian 1 Email

Parent/Guardian 2 Email

Emergency Contact Information

Please add the name and cell phone number of at least one emergency contact (other than parents/guardians) who can be reached in case of an emergency.

Authorized Pick-Up

If someone other than the parent/guardian or emergency contact person will pick up your child(ren) from their sample day, please list their name and cell phone number here.

Sample Day Form