Kidz Kraftz 7690 Quail Creek Circle, Dublin, CA 94568 www.KidzKraftz.com ♦ (925) 271-0015 ♦ [email protected]

2017 Student Registration/Project Release Form Student Name_______________________________________________ Date____/____/_____ Child’s School_____________________________ Grade___ Age___ Birth Date____/____/____ Parent/Guardian Name(s)________________________________________________________ Address______________________________________________________________________ City ________________________________________ State__________ Zip_______________ Home Phone (____)____________________ Mobile Phone (____)________________________ Work Phone (____)____________________ E-Mail ___________________________________ How I heard about KIDZ KRAFTZ!: Friends Flyers in ____________________

Advertisement in ______________________

E-mail

Mailing Other ______________________ Web Search Keywords ___________________________ If you are not registering for the Summer Camp, please skip the section below! Summer Camp Sessions

A

B

Summer Camp Sessions

Session 1 (6/5 - 6/9)

Session 6

(7/10 - 7/14)

Session 2 (6/12 - 6/16)

Session 7

(7/17 – 7/21)

Session 3 (6/19 - 6/23)

Session 8

(7/24 - 7/28)

Session 4 (6/26 – 6/30)

Session 9

(7/31 - 8/4)

Session 5 (7/3 - 7/7)* *(4 days camp)

Session 10 (8/7 - 8/11) Session 11 (8/14 - 8/19)

A

Session Options

B

Session A: 10:30 a.m. – 1 p.m. Session B: 2 p.m. – 4:30 p.m. Full Day*: 10:30 a.m. – 4:30 p.m. (*please mark both A and B checkboxes)

~ Combo Packages Available ~

Special Request(s): Combo packages, additional session week(s), start/end time(s) adjustments; Early drop-off and/or late pick-up available (15 min. maximum each).

Extended Care: Available upon request from 9 - 10:30 a.m., and from 4:30 – 7 p.m. The fee is $20/hr per person (A.M.) and $15/hr per person (P.M.), and is pro-rated. Please specify hours requested.

Special Dietary Needs:

Hold Harmless/Photo Release Agreement: I, the undersigned, agree to hold Kidz Kraftz! (a.k.a. DoReMi Design) harmless for any accident that may occur to me and/or my child while attending jewelry-making and/or sewing classes. I understand that after the start of the class or camp no full or partial tuition fee refunds will be provided for the days my child and/or I attended. I, the undersigned, also hereby authorize Kidz Kraftz! to make photo image(s) of me and/or my child and/or my/his/her/our jewelry-making and/or sewing projects, during participation in any of Kidz Kraftz! classes, birthday parties, camps, and/or any special events for the purpose of posting on website, advertising and in print/online media publications. I understand that my participation is voluntary and I will not seek compensation for the Kidz Kraftz!’s use of me and/or my child’s photograph(s).

Parent/Guardian Signature__________________________________________ Date____/____/______ Copyright © 2007-2017 KIDZ KRAFTZ! All Rights Reserved.

2017 Summer Camp RegFormAndProjectReleaseForm_secured.pdf

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