ELA Afterschool Application- PK-8 (2024-2025)

Knowledge Quest- Extended Learning Academies- Afterschool Programming Register Pre-Kindergarten-8th Grade students for daily afterschool programming in Knowledge Quest's Extended Learning Academies. Please note-- PreK is only open to students that attend Knowledge Quest's full day preschool program, the Early Childhood Academy (ECA). Students from any other schools will not be accepted.

"*" indicates required fields

ELA Afterschool Student Application

Please fill out this application carefully and double check to ensure that all information provided is accurate and correct (including spelling).

KQ Campus:*

Participant's Name*

First MI Last Optional: Jr., etc.

Family History with Knowledge Quest

Please provide all information about previous enrollment or participation that this child or other family members have had with Knowledge Quest programming.

Returning student?*

If yes, when?*

Have sibling(s) enrolled in KQ?*

When did siblings attend?*

Participant Information

Provide information about your child. Please check to ensure accuracy!

Name*

First Last

Date of Birth:*

Gender:*

Male

Female

Other

Prefer not to answer

Age:

Please enter a number from 4 to 19.

Race(s) & Ethnicity:*

Black or African American

White

Asian

Native American

Hispanic or Latino

Prefer not to answer

Any Legal Alerts?*

If yes, explain:

Home Address:*

Street Address Apartment # City State ZIP Code

Length of Residence*

Student Cell?*

If yes, provide number:

Parent or Guardian Information

Provide information for the primary caregiver for this child.

Guardian Name:*

First Last

Relationship:*

Is this person completing the form?*

Yes

Yes, with assistance.

If no, who is?

First Last

Guardian Address*

Same as child

Street Address Apartment # City State ZIP Code

Phone Number:*

Email:

Authorized Pick Up?*

Primary Contact?*

Legal Guardian?*

If no, who is the child's Legal Guardian?*

First Last

Parent Guardian Additional Information

Please provide demographic information about the parent/guardian listed above.

Relationship Status:*

Education Level:*

Employment Status:*

Full-Time

Part-Time

Unemployed

Not working

Employer Name:*

Job Title or Position:

Work Phone:

Work Address (Optional)

Street Address Address Line 2 City State ZIP Code

Add Parent/ Guardian?*

Parent/Guardian Information #2

Optional: contact information for a second parent or guardian.

Parent/Guardian Name:*

First Last

Relationship:*

Phone Number:*

Email:

Does this person live with child?*

Address*

Same as child

Street Address Apartment # City State ZIP Code

Authorized Pick Up?*

Education Level:*

Employment Status:*

Full-Time

Part-Time

Unemployed

Not working

School Information

Please provide information about the school and grade this child will be attending in the fall of 2024.

Participant's School:*

If Other, what school?*

Current Grade Level:*

Student ID Number:*

Student State ID #

Does student receive additional Educational Programs & Services through school?*

504 (Behavior Plan)

IEP

Special Education

Other

No education services in place

Household Information

Please provide accurate demographic information about the household. This information is for data purposes and will not be shared.

Type of Residence*

Apartment

House

Other

Rehousing or Homelessness in past 18 months?*

Yes

How many adults (anyone 18+) live in household with child?*

Please enter a number from 1 to 15.

How many children (anyone under 18) live in household? Including this child.*

Please enter a number from 1 to 15.

Members of Household*

Select the family members who currently live with this child.

How many brothers live with child?*