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KOC Waitlist
KOC Waitlist
Please complete the below form if you are interested in adding your child to a waitlist for a Kids on Campus class. You must complete the entire form, as it will serve as your registration form should a seat become available.
Student Information
First Name
*
Last Name
*
Address
*
City
*
State
*
Select One:
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Zip Code
*
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*
Date of Birth (mm/dd/yyyy)
OR
I am over 16 years of age
Male
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Are you of Hispanic or Latino origin?
Yes
No
What is your race? Select one or more of the following categories:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Click here to see a list of category definitions
Parent or Guardian Information
Parent or Guardian Name:
*
Parent or Guardian Home Phone
Parent or Guardian Cell Phone
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Parent or Guardian Email:
*
Waitlist
Course Information
Class 1
Course Title
Course Number & Section
Course Start Date
Class 2
Course Title
Course Number & Section
Course Start Date
Class 3
Course Title
Course Number & Section
Course Start Date
Permission
YOU MUST CERTIFY IN ORDER TO PROCEED: I certify that I am the parent or guardian of the child described above and the information presented here is correct to the best of my knowledge. THIS CERTIFICATION CONSTITUTES MY ELECTRONIC SIGNATURE.
*
Hitting “Submit” constitutes your legal signature.
Do not fill in this field:
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