Contact Inforation

E-mail Address where you'd like to receive confirmation and information:

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Student Information

Date of Birth:


Consent Statement

As the parent/guardian of the above-named student, I certify that my child/ward has my permission to attend and participate in the Kids-N-Technology (KNT) computer program and that he/she elects to engage in all program activities, at his/her own risk and hereby consent to hold harmless and release KNT and its owners, successors, agents, and employees from any and all liability that may accrue from personal injuries to said applicant. I also understand that if my child does not conform to the behavior expectations and rules of the program, KIT reserve the right to dismiss my child/ward and that there shall be no refunds for such dismissal. I further understand that I will be responsible for any personal or property damage incurred by my child/ward while participating program and that KIT is not responsible for personal belongings lost, damaged, or stolen.Furthermore, I understand that KNT often takes photographs or videos of participants during its activities or events. I grant permission without compensation that these photographs or videos may be used in publications, presentations, websites or promotion of KNT. Finally, KNT will not identify me or my child by name, or release any other personal information without additional written permission from me.

Electronic Signature: By entering my name below, I accept the above conditions and releases. (You must be 18 years old or over to sign below.) *

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