Student Name:___________________


(School Year 2023-2024)

ο     Application

ο     Tell Us A Little Bit About Your Child

ο     Parental Consent and Medical Care Authorization

ο     Program Decision to NOT Administer Prescription Medications

ο     Financial Policy Agreement (Both parents must sign)

ο     Media Release

ο     Movie Release

ο     Electronics Release

ο     Birth Certificate

ο     Immunization Records

ο     Paid Registration ($50 per child)

ο     Paid Activity Fee ($25 for FT; $20 for PT)

ο     Notify Celebrate KIDS! of your child’s start date

ο     Notify your child’s school that your child will ride on the Celebrate KIDS! van
Students are not considered enrolled until ALL paperwork has been submitted.

Contact Susan Belisle at 540-797-7332 if you have questions.