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*

Zip Code*

County (ex. Baltimore)*

Date of Birth (mm/dd/yyyy)

I am over 16 years of age

Male

Female

Are you of Hispanic or Latino origin?

Yes

What is your race? Select one or more of the following categories:

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

Parent or Guardian Business Phone

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.

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