Good success Kaleidoscope kids Online Registration

Registration

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Welcome to Good Success Kaleidoscope Kids after school/ OST Program 2025/2026.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Childs Last Name

financial account Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info (Not Contact #1 or #2)*

Health Insurance Carrier

Authorized Pick up 1*

Cell/Relationship*

Authorized Pick up 2

Cell/Relationship

Contact #1

Guardian #1 information First Name*

Last Name *

relationship*

How Can We Contact You?

Home Phone *

Work # *

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer*

Employer Phone*

Employer Notes

Contact #2

Guardian #2 information First Name*

Last Name*

relationship*

How can we contact you?

Home Phone *

Work # *

Cell # *

Email* (Emails are kept confidential)

Confirm Email*

Who is your employer?

Employer*

Employer Phone*

Employer Notes

Student #1

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

photo permission yes*

Field trip permission yes

Please use the class feature to enroll your child in their grade.

For half day scholarships parents please use category 2. "Half Day Scholarship"

Approved Half-Days:

Friday, October 10, 2025

Wednesday, November 26, 2025

Tuesday, December 23, 2025

Friday, January 16, 2026

Thursday, March 19, 2026

Tuesday, May 5, 2026

Thank you for your registration.

Classes are age appropriate.

Classes are in separated locations based on age.

Activities are based on classes

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

photo permission yes*

Field trip permission yes

Please use the class feature to enroll your child in their grade.

For half day scholarships parents please use category 2. "Half Day Scholarship"

Approved Half-Days:

Friday, October 10, 2025

Wednesday, November 26, 2025

Tuesday, December 23, 2025

Friday, January 16, 2026

Thursday, March 19, 2026

Tuesday, May 5, 2026

Thank you for your registration.

Classes are age appropriate.

Classes are in separated locations based on age.

Activities are based on classes

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

photo permission yes*

Field trip permission yes

Please use the class feature to enroll your child in their grade.

For half day scholarships parents please use category 2. "Half Day Scholarship"

Approved Half-Days:

Friday, October 10, 2025

Wednesday, November 26, 2025

Tuesday, December 23, 2025

Friday, January 16, 2026

Thursday, March 19, 2026

Tuesday, May 5, 2026

Thank you for your registration.

Classes are age appropriate.

Classes are in separated locations based on age.

Activities are based on classes

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

photo permission yes*

Field trip permission yes

Please use the class feature to enroll your child in their grade.

For half day scholarships parents please use category 2. "Half Day Scholarship"

Approved Half-Days:

Friday, October 10, 2025

Wednesday, November 26, 2025

Tuesday, December 23, 2025

Friday, January 16, 2026

Thursday, March 19, 2026

Tuesday, May 5, 2026

Thank you for your registration.

Classes are age appropriate.

Classes are in separated locations based on age.

Activities are based on classes

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Birth Date*

Additional Info

T-Shirt Size

School*

Grade Level*

Disabilities*

Special Needs*

Allergies*

Medications*

Primary Doctor*

photo permission yes*

Field trip permission yes

Please use the class feature to enroll your child in their grade.

For half day scholarships parents please use category 2. "Half Day Scholarship"

Approved Half-Days:

Friday, October 10, 2025

Wednesday, November 26, 2025

Tuesday, December 23, 2025

Friday, January 16, 2026

Thursday, March 19, 2026

Tuesday, May 5, 2026

Thank you for your registration.

Classes are age appropriate.

Classes are in separated locations based on age.

Activities are based on classes

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Registration

Referral Information

Childs Last Name

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Required Policies

(Show-Hide Details)