Welcome to Kidz Klub

We’re excited to have your child join us in Kidz Klub for a fun and engaging experience at the Oley Foundation Annual Conference. Kidz Klub is designed for children ages 4-12, providing a safe and supportive environment where they can connect with others, enjoy creative activities, and learn in a way that’s fun and meaningful. Our program is open to children on nutrition support, their siblings, and kids of adult attendees. (NOTE: Kidz Klub is available for ages 4-12, Exceptions above this age range may be considered on a case-by-case basis. Examples are being a teenager in this developmental age range. Please contact the office if you are interested in further information.)

Please complete this form for EACH of your children attending Kidz Klub to help us ensure your child has the best possible experience. The information provided will help our volunteers and staff create a safe, inclusive, and enjoyable space for all participants.

CONFIDENTIAL AND PRIVATE SECTION

Answers to the following questions will not be shared with anyone outside of Oley Staff and trusted volunteers for the purpose of Kidz Klub safety.

Child's Information

Childs First Name

Childs Last Name

Date of Birth

Parent/Legal Guardian Information

First Name

Last Name

Email Address

Cell Phone Number

Please provide an additional emergency contact person in the event you cannot be reached:

First Name

Last Name

Phone Number

Oley photo permission (We are not responsible for conference attendees who take photos of your child while in a public setting.)

NoYes

Language Information

What is your child's primary language?

Is this your child's only spoken language? If no, list other languages here

For the next questions, we are not asking for a full detailed medical history, only those things relevant to time in Kidz Klub. If you’d prefer to talk to someone about these over the phone, please reach out and an Oley staff member will contact you.

(NOTE: Food is not provided during normal Kidz Klub sessions. During our movie night, Jammin Jammies, we will have a snack table. Parents must approve what their child may or may not have before dropping off their child for the night. Allergy information, food limitations, and water consumption information are still important in case children sneak food into Kidz Klub or try to trade snacks.)

What food allergies or food limitations does your child have, if any? This includes if your child cannot eat anything orally and foods to avoid for ostomy bags. Please describe

Is your child able to drink water while attending Kidz Klub?

NoYes

What physical or mental limitations, disabilities, sensitivities, or behaviors, if any, should we know about to better care for your child while in Kidz Klub? (It is helpful for the staff to know which kids have medical devices to safely supervise them)

Please Describe

Are there signs we should look for in your child pertaining to medical needs that might warrant us calling you?

If yes, what would those signs look like?

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