Khalsa PTO Mixer Childcare

2018 PTO Mixer Childcare Form

We look forward to seeing you at the PTO Mixer on Oct. 25! If you will be using Khalsa Childcare during the Mixer, please fill out the Childcare form below and submit payment of $5 per student on the following page. Click here if you prefer to print out the Childcare form and return it with payment to the school office before Oct. 25.

* Indicates required field

Student's Name *

First

Last

Names of siblings also in Mixer childcare, and at which campus (Elem. or Primary) *

Parent's Contact Name *

First

Last

Contact Number on Oct. 25 *

In case of emergency, who else can we contact? (Name, relationship, and contact number) *

Any medical conditions and symptoms we should be aware of? How should we treat this condition should it arise? *

Students will be served food in childcare. Which food items will your kid(s) likely eat? (If none, you may want to pack food for your students). *

Other Comments *

By clicking the submit button, I agree to the following:
I will pay the $5 per student cost for child care during the Mixer. I, being the natural parent and/or legal guardian of the student(s) listed above, hereby give consent for my child(ren) to be cared for by the adults hired by the KMS PTO. Further, in the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the childcare adults to hospitalize, secure proper treatment for, and to order injections, anesthesia, or surgery for my child(ren) named above. I fully understand the consequences of this statement and hereby release the Khalsa School, PTO, and attending physical of any liability arising from my desire to have the conditions fulfilled.

Submit

Email us:

kmspto@gmail.com

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to attend a pto meeting:

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to contact Khalsa montessori school:

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