2024 – 2024 Enrollment

To enroll your child, please fill out the followiing enrollment form. If you have any questions, please contact us at 856-316-6375 or 609-617-5310.

Step 1 of 10

Early Registration
Step 1-School Selection
Please Select School District*
- Clayton Borough
- Gloucester City
- Monroe Township
- Washington Township
- Woodbury Heights
Please Note, currently, there are no Pre-K services available for Woodbury Heights.
Please Note, currently, there are no Pre-K services available for the Radix School, Monroe Township.
Are you planning on applying for a State Voucher?*
- Yes
- No
How Many Children Will You Be Enrolling?
Number of Children*
Please enter a number from 1 to 4.

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Parental/Guardian Information
Please fill out the following information below. Please note that children must be potty trained to attend the before and after school program.
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone Number
Mobile Number
Work Phone Number
Drivers Licence Number
Email*
Enter Email Confirm Email

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Please Select the Option That Applies
Select Which Program*
- Morning Care
- Afternoon Care
- AM and PM Care
- Day Passes
- Drop In Care
Do you plan on using a state voucher? Please check if 'Yes'.
- YES. I will be using a state voucher.
Please contact Kim Greer at 856-316-6375 for additional instructions regarding the use of a state voucher.
Note: Payments are debited/charged the first of the month. If you wish to cancel care written notice is required (forms are at each site). If you cancel care sometime during the current months care that month’s tuition will not be refunded, nor credit placed onto the account, the account would be cancelled the first of the next month.**If your child takes medication on a daily basis or needs medication dispensed to them please request our medication form. Parents Initials:*

Pleae type in Initials
Were You Referred By:
Emergency Contacts (Please List Three Contacts)
Emergency Contact Name (1)*
First Last
Emergency Contact Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Emergency Contact Phone
Emergency Mobile Phone Number
Emergency Contact Name (2)
First Last
Emergency Contact Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Emergency Mobile Phone Number
Emergency Contact Name (3)
First Last
Emergency Contact Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Emergency Mobile Phone Number
Emergency Contact Phone

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AUTHORIZATION FOR EMERGENCY MEDICAL CARE
I, the undersigned, understand that if emergency medical care is deemed necessary by a medical physician and that if I cannot be contacted, I hereby authorize my Kids Choice child care provider to act on my behalf in granting permission for my child(ren) to receive treatment as specified: In the event of a serious injury the local Ambulance Squad will be contacted immediately. After this initial call, contact will be made to the parents or the emergency contact. The director or the onsite supervisor will accompany the child to the emergency room and await the arrival of the parents or emergency contact. If a child is experiencing an illness he or she will be attended to by a Kids Choice employee and the parent or emergency contact will be contacted.
Please list below your children to receive medical care.
Please type your name:*
Parent/Guardian Signature-Please Sign*
Please sign your name using your mouse or touchpad. For touchscreens or mobile smart phones, use your finger to sign your name.
Date*
MM slash DD slash YYYY
Medical Information
Insurance Company:
Insurance ID#:
Policy Holder:
Primary Doctor:
Primary Doctors Phone #:
I, hereby; certify that the above, and the attached, information is true and accurate to the best of my knowledge. I acknowledge that upon enrollment that I, and my child(ren), will abide by the policies and procedures of Kids Choice. As described under the Kids Choice Policies and Procedures.
Please Print Name*
Parent/Guardian Signature-Please Sign*
Please sign your name using your mouse or touchpad. For touchscreens or mobile smart phones, use your finger to sign your name.
Date*
MM slash DD slash YYYY

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Policy Injury Reporting Procedures
It is the policy of Kids Choice that parents/guardians shall be notified of all injuries that require care. The method and means of contact shall be done in the following manner;
Injury above shoulder areas
(1) The parent shall be called and informed via phone of the incident and what actions are being taken to address the injury, ex. Ice being applied, observation, etc. (2) If you would like a copy of the written report we will provide on for you within 24 hours, unless that falls over the weekend or holiday. In that case, you will receive documentation on the next business day.
Injury below shoulder areas:
(1) The parent shall be contacted via the preferred method of contact they have chosen in the following, (a) Phone call (b) Text message (c) Email (2) This call, message or email shall consist of the following (a) Nature of injury (b) Actions taken (c) Childs comfort, ex. Resumed playing
Please indicate your preferred method of contact below, thank you.
Please List Phone Number
Please List Text Message
Please List Email
Please Print Name*
Parent/Guardian Signature-Please Sign*
Please sign your name using your mouse or touchpad. For touchscreens or mobile smart phones, use your finger to sign your name.
Date*
MM slash DD slash YYYY

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Photo Release
Photo Release Permission Slip
As the parent/guardian of this student, I hereby consent to the use of photographs/videotape taken during the course of the school year for publicity, promotional and or/educational purposes (including publications, presentations or broadcast via newspaper, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages. I understand that my child’s name will NOT be used in any publications of any sort.
- Yes, I give Kids Choice permission to photograph my child at Kids Choice.
- No I do not authorize my child to be photographed for any event.
Please Print Name*
Parent/Guardian Signature-Please Sign*
Please sign your name using your mouse or touchpad. For touchscreens or mobile smart phones, use your finger to sign your name.
Date*
MM slash DD slash YYYY

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Electronic Devices/Equipment Usage Policy
As per State Guidelines Kids Choice has a procedure regarding electronic devices and usage. Electronic devices are permitted but they must be limited to educational and instructional age-appropriate use. Also, as per the State the devices cannot be utilized in place of planned activities or passive doings. It is the policy of Kids Choice that electronic equipment and devices can be utilized in the program under the following conditions.
• No cell phones.
• No Internet access.
• Educational and Instructional use.
• Age appropriate
• If planned activities are organized, no electronic devices shall be utilized.
• Limited usage not to exceed 20 minutes per session.
Please Initial: Electronic Devices/Equipment Usage Policy

Please type in Initials

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NJ State Required Information
According to the State of New Jersey's child care licensing requirements, it is required that you are provided with the attached informational statement. The statement highlights, among other things; your right to visit and observe our center at any time without having to secure prior permission; the center's obligation to be licensed and to comply with the licensing standards: and the obligation of all citizens to report suspected child abuse/neglect/exploitation to the State Child Abuse Hotline 1(877) NJ ABUSE Please read this statement carefully and, if you have any questions, feel free to contact us at: 856-316-6375. Please complete the information below as part of your registration packet.
Click to Read the State Required Information
Please enter the parent(s) and child(s) names below.
Parent's Name **
Parent's Name
Child's Name **
Child's Name
Child's Name
I acknowledge that I have read and received a copy of the information to the parents statement prepared by the Office of Licensing, Child Care and Youth Residential Licensing, in the Department of Children and Families.
Parent/Guardian Signature-Please Sign **
Please sign your name using your mouse or touchpad. For touchscreens or mobile smart phones, use your finger to sign your name.
Date *
MM slash DD slash YYYY
Thank you for completing registration.
Name
This field is for validation purposes and should be left unchanged.

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2024 – 2024 Enrollment

Step 1 of 10

Early Registration

Step 1-School Selection

How Many Children Will You Be Enrolling?

Please Provide Information for Each Child to be Enrolled

First Child

Second Child

Third Child

Fourth Child

Address & Phone Number

Parental/Guardian Information

Please Select the Option That Applies

Emergency Contacts (Please List Three Contacts)

Authorized Persons For Pickups

Medical Information

AUTHORIZATION FOR EMERGENCY MEDICAL CARE

Medical Information

I, hereby; certify that the above, and the attached, information is true and accurate to the best of my knowledge. I acknowledge that upon enrollment that I, and my child(ren), will abide by the policies and procedures of Kids Choice. As described under the Kids Choice Policies and Procedures.

Policy Injury Reporting Procedures

Injury above shoulder areas

Injury below shoulder areas:

Please indicate your preferred method of contact below, thank you.

Photo Release

Electronic Devices/Equipment Usage Policy

NJ State Required Information

Click to Read the State Required Information

I acknowledge that I have read and received a copy of the information to the parents statement prepared by the Office of Licensing, Child Care and Youth Residential Licensing, in the Department of Children and Families.

Thank you for completing registration.

856-316-6375 or 609-617-5310

Copyright 2018-2021 Kids Choice