Registration Form
Wildkind / Wonderwell
Name of Participant
First Name
Last Name
Participant Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Parent/Guardian #1
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Parent/Guardian #2
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Emergency Contact
First and Last Name
Relationship to Participant
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Below is a space for any applicable information in regards to the participant that would support their success in Keeper + Wee programming. All shared information is of course confidential and would only be used by the facilitator to best meet the individual needs of the child.
*
At K E E P E R + W E E, your child’s safety and well-being are always our priority. We take great care to create a nurturing and supportive environment. As with any recreational or skill-building program, there are natural risks that come with play and exploration. By signing below, you acknowledge, understand and accept these risks and declare your choice to waive all liability, allowing us to focus on providing the safest, most enriching experience possible for your child.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Payment
The cost of Wildkind / Wonderwell is 440.00+ tax. Currently we only accept e-transfers. Payment can be sent to thekeeperandwee@gmail.com. Keep your eyes peeled, Keeper + Wee will send a receipt of purchase, as well as, information in regards to attire, outdoor gear and the building security code. Thank you for supporting a local business!
SUBMIT
SUBMIT
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