Kings Rd. School - BASCC Registration Form The Thursday Morning Club / Madison Community House does not discriminate and prohibits discrimination, as required by state and/or federal law, in all programs and activities, including employment and access to programs. Registration Form (PDF) Kings Rd. School - BASCC Registration Form Child's Name* First Last Child – Grade / Teacher in September* Add another child SiblingSibling – Grade / Teacher in SeptemberSiblingSibling – Grade / Teacher in SeptemberHome Address* Street Address City ZIP / Postal Code Parent/Guardian Name* First Last Phone Number*Cell PhoneI am interested in the following schedule:Select all applicable days and schedulesAM Only Monday Tuesday Wednesday Thursday Friday PM to 5:15 Only Monday Tuesday Wednesday Thursday Friday PM to 6:15 Only Monday Tuesday Wednesday Thursday Friday AM & PM to 5:15 Monday Tuesday Wednesday Thursday Friday AM & PM to 6:15 Monday Tuesday Wednesday Thursday Friday Registering for Drop In Use*YesNoAny diagnosed allergies?* Yes No Registration Fee* Price: $60.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Parent/Guardian Signature* This iframe contains the logic required to handle Ajax powered Gravity Forms.