Which one of our awesome Coding Reps did you meet? *

Student First Name *

Student Last Name *

Parent Name *

Email *

School Name *

Phone *

Date of birth *

Gender *

Homeroom Teacher *

Last name only

Standard Dismissal *

Bus Number *

How will your child be dismissed from Kids Can Code? *

Students may not bike/ walk home- a parent must be present at dismissal

Does your child have any allergies or dietary restrictions? *

Will your child bring their own device, or will they need to rent a device? *

What experience does your child have with coding, robotics, game design? *

None – This is their first experience

Beginner – They've played with coding games like Scratch or Code.org

Intermediate – They’ve used tools like Minecraft Education, Ozobots, or built basic games

Advanced – They’ve taken a class or built projects using tools like Python, Roblox Studio, or Arduino

I grant permission to use photographs and/or videos taken of my child in publications, news releases, online, and in other communications related to the mission of Kids Can Code. No names, ages, or private information will be shared. *

Yes, you may post pictures and videos.

No, you may not post pictures and videos.

What would you like your child to learn or gain from this session? *Choose all that apply

Does your child have any learning differences or specific needs we should be aware of to better support them during class? *

My child has an IEP

My child has a diagnosis that may affect their experience in class

My child has a learning difference

Is there anything you'd like us to know about how we can best support your child? *

This helps us provide a safe and fun environment for everyone.

Additional Authorized Pickup Persons *

Emergency Contact
Authorized Pick Up
Authorized Pick Up
Authorized Pick Up

List names and phone numbers

How Did You Hear About Us? *

Waivers

Class Refund Policy

Full Refund:

Registrants are eligible for a full refund if they cancel their registration within 48 hours of purchase. The refund will be processed to the original payment method.

Refund Method:

Registrants will receive a credit balance towards future classes with a cancellation fee of $20.00.

Cancellation Fee:

A flat cancellation fee of $20.00 will be charged for cancellations made outside the 48-hour window.

Enrollment Details:

If minimum enrollment not met, club will be canceled and parents will be notified the Sunday prior. If payment has already been accepted, registered students will receive a Kids Can Code family credit for use towards a future camp or class. Registration deposits are non-refundable.

Session Time = 1.15 hour/ week, so a session will have about 15-18 hours of contact time.

All sessions are built with "flex time" which allows for one hour class cancelation if needed. Most classes meet for 1 hour and 15 minutes, resulting in almost 3 hours of extra contact time in a session. If class is never canceled, your child gets bonus coding time!

One class may be canceled per session (due to campus closure or instructor illness) without rescheduling.

If make up time is needed and can not be scheduled, participants will receive a Kids Can Code credit to be used for a future class or event.

Behavior Expectation Acknowledgement

Kid coders must exhibit acceptable behavior throughout each event. This enrichment is academic in nature, with an opening lesson and individualized work time. Coders should be respectful and follow directions. Coders must be willing to collaborate with teammates.

Kid coders will get out of the enrichment what they are willing to put in! If they stay focused, push through struggles, and seek assistance, they will thrive. Kid coders do not have to get everything correct the first, second, or even third time... coding is about the PROCESS, not PERFECTION!

Parents will be contacted via email if unacceptable behavior is repeatedly displayed. If behavior is not corrected, coders will be asked not to return, with no refund given.

Hold Harmless Agreement

I, the undersigned participant, am requesting participation in Kids Can Code event, all of which are hereinafter referred to as the activity. In consideration of my child’s participation in the activity, I hereby waive all claims or causes of action against the State of Florida, the Regents of Kids Can Code LLC, its auxiliary organizations, and the employees all of which are collectively hereinafter referred to as a State, arising out of my participation in the activity and hereby release, hold harmless, and discharge the State from all liability in connection therewith. Knowing, understanding, and fully appreciating all possible risks, I hereby expressly, voluntarily, and willingly assume all risks and dangers associated with my child's participation in this activity. I agree to use my child's personal medical insurance as a primary medical coverage payment if accident or injury occurs. I have read this waiver/release and understand the terms used in it and their legal significance. This waiver and release is freely and voluntarily given with the understanding that the right to legal recourse against the State is, knowingly, given up in return for allowing my child's participation in the activity. My e-signature on this document is intended to bind not only myself but also my successors, heirs, representatives, administrators, and assignees.

Technology Agreement

I understand that it is my child’s responsibility to take care of his/ her technology. I will not hold Kids Can Code liable for any broken or lost devices.
I will download all necessary apps prior to enrichments starting.
I will disable downtime restrictions during the hours/ days of my child's enrichment.
If my child requires a one-time "loaner device" I will contact his/ her instructor prior to the day of class (i.e. your child's ipad is broken and getting replaced).
If my child is registered to borrow a device each week, I will pay for any damages to the device incurred by my child.

*I understand that if I do not adhere to the above technology agreements, my child may not be able to participate in the enrichment activities.

Electronic Signature Acknowledgement *

Clear

I agree to the above policies and procedures

By checking this box, I consent to receive transactional messages from Kids Can Code related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages from Kids Can Code, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Patriot Oaks Academy

Fridays from 2:20 - 3:45

Let’s Get Your Child Registered!