Little Readers Registration Form

Little Readers Registration Form
Child's Name:*

First NameLast Name
Children's Books Authurs

Betty Baumgardner

Mark Goldman

Lisa Iacoletti
Little Readers

Free with the purchase of Open Play

1 open play (1 child) for $16.00

Please register and pay in advance.

Ages: 3-6
Please Select Day:

Monday 11/24 - 4:00 PM - Lisa IacolettiTuesday 11/25 - 11:00AM - Mark GoldmanWednesday 11/26 - 4:00PM - Betty Baumgardner/Jonna Baumgardner
Child's Information:
Child's Name:*

First NameLast Name
Age:*
Birthday:*

MonthDayYear
Date
Gender:*

MaleFemale

Acknowledgment, Authorization, and Waiver

This child has my authorization to engage in the activities of the WEROCK program.

I allow taking photographs of this child that can be used for WEROCK portfolio or advertising.

I authorized WEROCK to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. I allow them to apply first aid, medical or surgical diagnosis and treatment as necessary.

I release WEROCK and any of its coaches, staff, and managers for any responsibility in case of accident, illness, or injury during the child's enrollment.
Photo authorization of my child:

I authorize photos of my child as indicated above.I do not authorize photos of my child.
Yes
Comments:
Date Signed:*

MonthDayYear
Date
Parent/Guardian Signature:*

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We Rock The Spectrum Cibolo Canyons
22250 Bulverde Rd Suite 116 San Antonio, TX 78261
210-796-9843
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Child's Information: