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Ashbury Kids Club
11740 S 120th St, Papillion, NE, 68046
Summer 2025 & School Year 25-26 New Registration Form - AB
1
Student Info
2
Parent Info
3
Authorized Pickup Info
4
Policy & Waiver
Student #1
First Name
Last Name
Date of Birth
Select date
Allergies
Medical Conditions, Behavioral Needs or Special Needs
Medication
Medical Provider
Medical Provider's Phone Number
Gender
Choose One
Home Address
I give permission for my child to be photographed for educational or promotional publicity purposes for Kids Club and the Papillion La Vista Community Schools Foundation.
Choose One
Do you receive Child Care Subsidy (Title XX) through DHHS? (If yes, you must have authorization approved by DHHS prior to your child attending Kids Club)
Choose One
Choose One 25-26 School Year Enrollment Option
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School Year Kids Club Site
Choose One
Anticipated School Year Start Date
Select date
Choose One Summer Enrollment 2025
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Summer Kids Club Site
Choose One
SUMMER KIDS CLUB SITE - 2ND CHOICE IF 1ST CHOICE IS FULL
Choose One
Anticipated Summer Start Date
Select date
SUMMER TSHIRT SIZE
Parent/Guardian Signature
Today's Date:
Select date
Add Student
Continue
Female
Male
Yes
No
Yes
No
AM ONLY: $131.00 bi-weekly, per child
PM ONLY: $163.00 bi-weekly, per child
AM/PM: $205.00 bi-weekly, per child
OUT OF SCHOOL DAYS ONLY: $45 per day, per child
NOT ATTENDING SCHOOL YEAR
ANDERSON GROVE
ASHBURY
BELL
CARRIAGE HILL
GOLDEN HILLS
G STANLEY HALL
HICKORY HILL
LAVISTA WEST
PARKVIEW HEIGHTS
PATRIOT
PORTAL
PRAIRIE QUEEN
RUMSEY STATION
TARA HEIGHTS
TRUMBLE PARK
WALNUT CREEK
NOT ATTENDING SCHOOL YEAR
Summer 2025: $430 bi-weekly, per child
Summer 2025 Drop In: $270 weekly, per child
Not attending Summer 2025
ASHBURY
BELL
CARRIAGE HILL (CLUB 56 ONLY, CHILD MUST CURRENTLY BE IN 5TH OR 6TH GRADE)
GOLDEN HILLS
G STANLEY HALL
LA VISTA WEST
PATRIOT
PRAIRIE QUEEN
RUMSEY STATION
WALNUT CREEK
NOT ATTENDING SUMMER
ASHBURY
BELL
CARRIAGE HILL (CLUB 56 ONLY, CHILD MUST CURRENTLY BE IN 5TH OR 6TH GRADE)
GOLDEN HILLS
G STANLEY HALL
LA VISTA WEST
PATRIOT
PRAIRIE QUEEN
RUMSEY STATION
WALNUT CREEK
NOT ATTENDING SUMMER