Winter/Spring 2020 ICC Children's Classes Registration

All About India

Fall 2023 @ YMCA of Greenwich

50 East Putnam Ave., Greenwich

Children must be 4 by August 31, 2023
Child's Name*

First Last
Birth Date*

MonthDayYear
Date
Gender*
School Attending *
2023/24 Grade*
Parent/Guardian Name*

FirstLast
Primary Phone #*
E-mail*
Medical Information
Physician's Name*

First Last
Physican's Phone*
Medical Concerns/Allergies*
If not applicable, write none
Does your child have any special learning needs? If None, write N/A. If yes, explain. *
I hereby authorize the ICC staff, teachers, and parents to act on my behalf in any emergency situations requiring medical attention. I also release and waive the staff, ICC Greenwich, parents and the facility for any illness or injury incurred by the above participant while at ICC or in transit to and from the classes. I further acknowledge that ICC Greenwich and the staff do not assume liability for the loss or damage to personal or other property.
Parent's Signature*

First NameLast Name
Date*

MonthDayYear
Date
Payment

All About India$375.00

Ten-week session $350 plus $25 materials fee

Enter coupon

Total $0.00