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.

Save and Continue Later

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

Save and Continue Later

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

Save and Continue Later

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

Save and Continue Later

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

NOTICE:

Once you register your child, we will contact you with the available start date.