TC Kid Crew

Step 1 of 3

33%

Parent/Guardian

Name(Required)

First Last

Relationship(Required)

Mother

Father

Foster Parent

Grandparent

Other

Primary Phone(Required)

Phone Type(Required)

Secondary Phone

Phone Type

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Employer(Required)

Work Phone

Are you enlisted in the military?(Required)

Yes

Where did you learn about us?

Family/Friend Referral

School

Website

Other

If other, please specify

Would you like to enter another parent/guardian?(Required)

Yes

Second Parent/Guardian

Name(Required)

First Last

Relationship(Required)

Mother

Father

Foster Parent

Grandparent

Other

Primary Phone(Required)

Phone Type(Required)

Secondary Phone

Phone Type

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Employer(Required)

Work Phone

Are you enlisted in the military?(Required)

Yes

Household Information

The following information is required for membership at the TC Kid Crew. This information will not be used individually but grouped for fundraising and grant writing. All information is held strictly confidential.

Number of people in your primary household(Required)

Please enter a number from 1 to 50.

Select a range for Annual Primary Household Income(Required)

Does your child receive free or reduced lunch?(Required)

Emergency Contacts (other than parents)

* Names listed are assumed to be authorized to pick up the child.

Emergency Contacts

First Last

Phone

List anyone not allowed to pick up child by court order

First Last

A document is needed if there are any custody orders involving restrictions or limitations of when any parent or guardian is allowed to drop off or pick up.

Child's Information

Name(Required)

First Last

Date Of Birth(Required)

MM slash DD slash YYYY

Gender(Required)

Grade(Required)

Child's Cell Phone #

Ethnicity(Required)

Race(Required)

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Biracial or Multiracial

Other

Living with(Required)

Mother

Father

Both

Joint Custody

Foster Family

Grandparent

Other

Current School(Required)

Medical Information

The questions below are designed to help us understand and work effectively with your child. You are not required to answer these questions; however, the lack of this information may affect our ability to work with your child.

Describe any unusual health related conditions of the child

Does your child have any physical or mental disabilities, developmental delays or emotional/behavioral disorders that we should be aware of the help your child be successful in the TC Kids Club?(Required)

Has your child experienced any emotional trauma?(Required)

Note: If you answered yes to either of the above two questions, an intake questionnaire will be provided for you, to detail your child's specific needs to insure success for your child.

Is your child receiving any services through Special Education?(Required)

Would you like to enter a second child's information?(Required)

Yes

Second Child's Information

Name(Required)

First Last

Date Of Birth(Required)

MM slash DD slash YYYY

Gender(Required)

Grade(Required)

Child's Cell Phone #

Ethnicity(Required)

Race(Required)

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Biracial or Multiracial

Other

Living with(Required)

Mother

Father

Both

Joint Custody

Foster Family

Grandparent

Other

Current School(Required)

Medical Information

Describe any unusual health related conditions of the child

Has your child experienced any emotional trauma?(Required)

Note: If you answered yes to either of the above two questions, an intake questionnaire will be provided for you, to detail your child's specific needs to insure success for your child.

Is your child receiving any services through Special Education?(Required)

Would you like to enter a third child's information?(Required)

Yes

Third Child's Information

Name(Required)

First Last

Date Of Birth(Required)

MM slash DD slash YYYY

Gender(Required)

Grade(Required)

Child's Cell Phone #

Ethnicity(Required)

Race(Required)

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Biracial or Multiracial

Other

Living with(Required)

Mother

Father

Both

Joint Custody

Foster Family

Grandparent

Other

Current School(Required)

Medical Information

Describe any unusual health related conditions of the child

Has your child experienced any emotional trauma?(Required)

Note: If you answered yes to either of the above two questions, an intake questionnaire will be provided for you, to detail your child's specific needs to insure success for your child.

Is your child receiving any services through Special Education?(Required)

Would you like to enter a fourth child's information?(Required)

Yes

Fourth Child's Information

Name(Required)

First Last

Date Of Birth(Required)

MM slash DD slash YYYY

Gender(Required)

Grade(Required)

Child's Cell Phone #

Ethnicity(Required)

Race(Required)

White

Black or African American

American Indian or Alaska Native

Asian

Native Hawaiian or Other Pacific Islander

Biracial or Multiracial

Other

Living with(Required)

Mother

Father

Both

Joint Custody

Foster Family

Grandparent

Other

Current School(Required)

Medical Information

Describe any unusual health related conditions of the child

Has your child experienced any emotional trauma?(Required)

Note: If you answered yes to either of the above two questions, an intake questionnaire will be provided for you, to detail your child's specific needs to insure success for your child.

Is your child receiving any services through Special Education?(Required)

Insurance Information

Insurance Company(Required)

Policy/Group Number(Required)

CAPTCHA

TC Kid Crew

TC Kid Crew Registration Form

Parent/Guardian

Second Parent/Guardian

Household Information

Emergency Contacts (other than parents)

Child's Information

Medical Information

Second Child's Information

Medical Information

Third Child's Information

Medical Information

Fourth Child's Information

Medical Information

Insurance Information