Friday Fun Club Registration

*Select Event:

Select the activity for which you are registering. Please check the date carefully

*Child's First Name:

First name of the first child you are registering

*Child's Last Name:

Last name of the first child you are registering

*Child's Date Of
Birth:

/ /	Child's date of birth. Please note the minimum age is three years of age, and your child must be able to use the bathroom unsupervised

*Child's Gender:

Boy
Girl

2nd Child's First
Name:

First name of the second child you are registering

2nd Child's Last
Name:

Last name of the second child you are registering

2nd Child's Date Of
Birth:

/ /	2nd child's date of birth. Please note the minimum age is three years of age, and your child must be able to use the bathroom unsupervised

2nd Child's Gender:

Boy
Girl


	Parent Information (parent who will drop off and pick up)

*Parent Name:

Name of parent contact for the duration of the Fun Club

*E-Mail Address:

You must provide a valid e-mail address. You will receive a confirmation at this address, and it is our primary method of non-emergency communication

*Day Phone:

- - x

Contact phone number where we can reach you during the day monday to friday

Evening Phone:

- -	Evening and/or weekend contact number. We will only use this if we need to contact you at these times to confirm registration details

*Contact Number:

- -	We MUST have a number on which we can reach you or your designated guardian DURING the Fun Club, for emergency contact purposes. This will typically be a cell phone number if you are out.

*Street Address:

We need your address to confirm your registration

*City:

*State:

*Zip:

Additional
Information:

(chars left: 500)

Provide any specific instructions or circumstances (e.g. allergies, concerns, different pick-up responsibilities)

*Terms & Conditions:

By checking this box, I am acknowledging that I realize that Kids Fun Inc. offers a comprehensive program of activities for children including various forms of exercise, dancing and tumbling that can result in physical injury. While the Dancercise® Kids instructors make every effort to ensure the children’s safety, I will not hold Kids Fun Inc., its employees or any of its subsidiaries or affiliates liable in the highly unlikely event that my child should sustain an injury. I agree to allow Kids Fun Inc. to use the likeness of my child in photographs and/or video solely for advertising and promotional purposes without compensation to my child or myself.

*Image Verification:

Enter the code above.

Please type the characters you see here. This is to prevent automatic spam generators from completing this form, thank you for helping us!