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.
