dharma Kids APPLICATION, 2024-2025

Please fill out this form to apply for Dharma Kids. Spots have historically filled up quickly. We will accept applications in the order they are received and notify you in a timely manner.

Please note: We ask that parents be present at the Dharma Center (upstairs in the the Shrine Room or with the children) during the duration of the program.

Thank you for your interest!

Application Date

YYYY

Child's Name

First Name

Last Name

Child's Birthdate

YYYY

School and Grade

Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Parent/Guardian Email Address

Parent/Guardian 2

First Name

Last Name

Address (if different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (if different)

(###)

###

####

Parent/Guardian 2 Email

Please share a few words about your child (ex: strengths, interests, challenges, concerns, hopes, dreams)

Any significant allergies, medical conditions, special needs or required medications?

May your child join us for walks during DharmaKids?

May we use your child's photo on our website/KSC informational material?

Volunteer opportunities: please share a few words about your interests, skills and strengths that you might be willing to share with DharmaKids.

Emergency contact if other than parent (Optional):

E-Signature

By submitting this form electronically, in connection with my voluntary involvement in activities undertaken for and with the participation and support of KSC, a non-profit organization, I hereby agree, for myself, my heirs, assigns, executors and administrators to release and discharge KSC, its officers and directors, employees, agents and volunteers from all claims, demands and actions for injuries sustained to my person and/or property as a result of my involvement in such activities, whether or not resulting from negligence, and I agree to release and hold KSC, its officers and directors, employees, agents and volunteers harmless from any cause of action, claim or suit arising therein. I hereby attest that my attendance and involvement in such activities is voluntary, that I am participating at my own risk, and that I have read the foregoing terms and conditions of this release.