KRE8TIVE KIDS CLASS REGISTRATION FORM

www.kre8tivekids.com

 

Child’s Name              __________________________           Date of Birth _________________

School Attending         _____________________________________          Grade ___________

Parent/Guardian          __________________________________________________________

Mailing Address           __________________________________________________________

City, State, Zip             __________________________________________________________

Home Phone               ______________________    Cell Phone   ________________________

Email Address                        _______________________________________________________

Special Needs or Requests (special diet, allergies, medical conditions, medications, disability)

___________________________________________________________________________

Emergency Contact: Should Parents Not Be Available:

 

Name                          ____________________________________________________

Relationship                ______________________    Phone Number ________________

Classes start the week of March 29, 2010 and run for 5 weeks.  Classes will be held at Horizon Presbyterian Church located at 1401 E. Liberty Lane in Phoenix, AZ  85048.

                              

Put an ‘X’ next to the classes being signed up for

 

1st Child

Siblings

TOTAL

___

Aviation 101

Mondays

3:15pm – 4:30pm

 

$95

$85 each

______

 

___

Leadership 101

Mondays

4:45pm – 6:00pm

 

$95

$85 each

______

 

___

Aviation 101

Wednesdays

1:45pm – 3:00pm

 

$95

$85 each

______

 

___

Leadership 101

Wednesdays

3:15pm – 4:30pm

 

$95

$85 each

______

 

___

Fashion 101

Wednesdays

4:45pm – 6:00pm

 

$95

$85 each

______

 

 

MAIL CHECKS PAYABLE TO :  Kre8tive Kids

 

 

TOTAL

$______

 

                                                        PO Box 93042, Phoenix, AZ  85070

Medical Waiver:

I understand that the child will be closely supervised and that if a serious illness or injury develops, medical and/or hospital care will be given.  I further understand that in case of medical emergency, I will be notified.  In the event that I cannot be reached, I hereby authorize any and all emergency medical examination and/or treatment necessary for the child’s safety and welfare.  I release Kre8tive Kids LLC, any authorized employee and/or volunteer of all liability in case of accidental injury or illness.

 

____________________________________________                    _______________________

Signature of Parent or Legal Guardian                                               Date