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2. School your child attends*

   1. Central Elementary

   1. Blythe

   1. Ames

   1. Hollywood School
4. As part of our KinderKids Kindergarten Enrichment Program through the Riverside Parks and Recreation Department, we offer to pick-up your child from school if school staff can accommodate the transition pick up time. Only children who attend District 96 Schools are eligible for pick-up since we have staffing and transportation constraints. Any parent/guardian who wishes to participate in Riverside Parks and Recreation staff pick-up must fill out this form by the KinderKids Form Return Deadline. Please adhere to the absence policies described in your parent manual. You must notify the District 96 School that our staff is allowed to pick-up your child after school, if we are not on the list of pick-up your child will not be allowed to be released to us for KinderKids Enrichment.
   
   If your child attends Central, Blythe, or Ames your child will be picked up via a Village of Riverside vehicle and; therefore, you will need to provide the Village with a car seat.
6. Child's Name
7. Date
   Date
9. Electronic Signature Agreement*

   By checking the "I agree" box below, you agree and acknowledge that
   
   1) your application will not be signed in the sense of a traditional paper document,
   2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and
   3) you may still be required to provide a traditional signature at a later date.
   
   By signing this form, I give permission for my child to be picked-up after school by Riverside Parks and Recreation staff for KinderKids Kindergarten Enrichment. I am responsible for notifying my child's teacher and the District 96 office of the transportation arrangement as well as notifying the Riverside Parks and Recreation Department of my child's absence as outlined in the parent manual.

   1. I agree.
11. Parent's Electronic Signature*
12. Date
    Date
Leave This Blank:


14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

* indicates a required field