Enroll with RMK!

Enrollment Application: Please complete the following webform to enroll each of your children individually with Rocky Mountain Kids. You should receive confirmation within 24 hours of submission. If you do not wish to transmit your data online, you may turn your hard copy application in to your on site director (downloadable below). Thank you and email us with any questions at rockymtnkidsinfo@gmail.com

If you are already enrolled, and need to update your card on file only, please click here
Child First Name
Email address (Primary)
Phone Number (Primary)
Is your child up to date on state required immunizations (Type Yes or No)
Child Last Name
Parent/Guardian #1 Name (First Last)
Parent/Guardian #2 Name (First Last)
Phone Number (Secondary)
Email address (Secondary)
Child Birth Date
School & Current Grade (Ex: Frontier, 5th)
Persons authorized to pick up child (Name, Number, Relationship;)
Doctor Name (First Last)
Doctor Phone Number
Clinic/Hospital of Choice (Name, Address)
Please list any allergies (If none, type none or N/A)
Please list any medications (If none, type none or N/A)
Please list any other medical conditions or concerns you would like our staff to be aware of:
Health Insurance Company:
Health Insurance Policy Number:
In case of emergency, I authorize the staff or physician to take action in best interest of my child's health. (Initial below)
I agree to abide by all policies and procedures stated in the Parent Handbook. (Initial below)
I consent that Rocky Mountain Kids is not liable for my child before check-in & after check-out with RMK. (Initial below)
I agree to keep my child's records up to date to the best of my ability. (Initial below)
Please list approved visual programming below: [None, TV programs, G-Rated Movies, and/or PG-Rated Movies]
I agree to allow RMK to occasionally photograph or video my child during program activities. (Initial below)
I agree to allow my child to be transported in an approved vehicle when necessary with RMK (Ex: Fieldtrip). (Initial below)
I give consent for Rocky Mountain Kids to apply sunscreen to my child as needed to avoid UV harm. (Initial below)
Full name of person consenting
Please list any specific activities you wish for your child to be excluded from:
Please select you preferred package: (Gold AM, Gold PM, Gold AM&PM, Silver, or Bronze)
Are you a US Uniformed Service-member, or Veteran? (Yes or No)
If yes and on site, will you be using Teacher Express? (Yes or No)
Full name of credit/debit card? (First MI Last)
Credit/Debit Card Number to be securely retained as primary form of payment? (List full number below)
Expiration date (MM/YY)
Security Code
Billing Zip Code
Security question to be used in case of emergency
Answer to security question:
I authorize my credit card to be charged in accordance with my package selection. (Initial below)
Are you an Aurora Public Schools Staff or Faculty? (Yes or No)
Are you an approved CCCAP recipient? (Yes or No)
Are you an approved free/reduced lunch program participant? (Yes or No)
Doctor Address
Dentist Name
Dentist Address
Dentist Phone Number
Submit
Downloadable Enrollment Form (Hard Copy Option)