Program ApplicationThank you for your interest in participating in KL Impact Academy Name * First Name Last Name Date of Birth MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * Enter your child's best number. If your child does not have a phone enter n/a (###) ### #### School * Current Grade * Parent/Guardian 1 * First Name Last Name Phone * (###) ### #### Email * Parent/Guardian 2 First Name Last Name Phone (###) ### #### Email Emergency Contact * First Name Last Name Phone * (###) ### #### Parent/Guardian Input * Please describe your applicant, let us know of any specific areas you'd like us to focus on, and why you believe they need to participate in KL Impact Academy. Will You Need Transportation * While we do our best to accommodate transportation needs, space is limited and not guaranteed. We encourage families to indicate their needs, and our team will follow up with availability based on capacity and route planning. Pick-up Drop-off Both How did you hear about us? * Friend/Family School Referral Facebook Instagram Other Thank you for completing the application!We’ve received your submission and appreciate your interest in our program.Please allow 3–5 business days for our team to review your application. You’ll receive a follow-up email or text with next steps or additional information.If you have any questions in the meantime, please contact Mrs. Jacque at📧 admin@mydaddytaughtmethat.org📞 828-226-8023