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2020-21 Virtual Afterschool Hangout Registration Form 

Child's Information

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Gender
Is the participant proficient in english?
Does your child have a documented disability?
Is the participant a child of the dependency system?
Other language(s) spoken in the home
Does Child Have a Documented Disability?
Ethnicity
Race
We want to get to know your child better so we can provide the best possible experience in our programs. Please tell us more about your child...
What, if any, help does your child receive at this time? (Mark all that apply)
What conditions does your child have that are expected to last for a year or more? (Mark all that apply)
During Phase B re-opening priority will be able to give to a student that transition to a hybrid on-site program.  The virtual program will be available for up to 40 students. Preference will be given to the first-come participants, there will be a waiting list for onsite once all slots are full.
Phase B Choice
To support your child’s successful participation in this program, in what areas might s/he need extra assistance?
How did you hear about us?
Do any of the conditions marked above make it harder for your child to do things that other children of the same age can do?

Knowledge Builders of Florida

After-School Technology Center

10750 SW 156 Terrace, Miami, Florida 33157

Phone: 305.234.1645

Email for info: info@kb-florida.org

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