After-School Registration & Payment

After-School Programs Registration & Payment Form

ALL PROGRAMS ARE LOCATED AT 592 PACIFIC ST BROOKLYN, NY 11217 (718) 857-5437
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Are you a returning student? *

YES NO
Has any information changed in the past 6 months? If yes, please fill in information below. *

YES NO
Student's Information

Please fill out all the information in this section below
Full Name *

First Name Last Name
Grade *
Date of Birth *
Gender
School they attend *
Do you have a sibling who will be joining you during a CBK class? *

YES NO
Sibling's Name

First Name Last Name
Grade
Date of Birth
Gender
School they attend
Please List all the classes siblings are joining together
+ Sibling
**IMPORTANT ** Please be advised that if any siblings are attending different classes you must register them separately
Parent or Guardian Information

Please fill out all the information in this section below
Name *

First Name Last Name
Relationship to Student *
E-mail *
Phone Number *

- Area Code Phone Number
Additional Phone Number

- Area Code Phone Number

Emergency Contact Information

Please fill out all the information in this section below
Name

First Name Last Name
Relationship to Student
E-mail
Phone Number

- Area Code Phone Number
Additional Information

Please fill the information in this section below
Allergies ( please list and explain all allergies; severity, seasonal etc. ) *
Any additional information we should know about your child
** The more information you can provide us regarding any special needs your child may have, the better we can assist your child during class **
Health Care Provider & Policy Number
After-School Programs List & Payment

Please select from the following options below. Wait for drop down menu and chose a quantity

My Products

Painting Class Extended ( MON. | May 8 - June 5 )

Spring 2017	Price	Quantity
4 weeks	$ 160.00
4 weeks \| with subway fee	$ 185.00

Ceramics | Pottery Wheel ( TUE. | April 25 - June 13 )

Spring 2017	Price	Quantity
8 weeks	$ 320.00
8 weeks \| with subway fee	$ 345.00

Mixed Media Design ( WED. | April 26 - June 14 )

Spring 2017	Price	Quantity
8 weeks	$ 320.00
8 weeks \| with subway fee	$ 345.00

Packer Sewing Class ( THURS. | April 27 - June 1 )

Spring 2017	Price	Quantity
6 weeks	$ 306.00

Enter coupon

10% Sibling Discount coupon code : S1BLING
PLEASE READ BEFORE MAKING PAYMENT

REFUND POLICY:

All registration sales are final; no refunds or credits will be issued. Fees may not be transferred to another semester. Created By Kids is not responsible for providing make-up classes or issuing reimbursements for classes changed or missed due to illness, emergency, weather closings, or other events beyond our control.

PAYMENT:

After you click the submit button, you will be redirected to the PAYPAL payment page. Registration will only be completed when Disclaimer is read and agreed upon.
I hereby authorize Created By Kids LLC. to take photographs, videos and images of my child during their time in our classes. I give Created By Kids permission to use my child's photo for their website, group photos, media and any form of marketing material used for Created By Kids.
Photo Authorization *

Agree Disagree
Disclaimer:

Participation in Created by Kids programs will involve children using tools and materials in a supervised but active setting. By registering, making payment to, and/or participating in Created By Kids classes, the participant’s Parent/Guardian understands and accepts the risks inherent in their child’s involvement with the program and will hereby release Created By Kids LLC, its owners, and employees from any liability or claim of any kind for damages and/or injuries that occurred as a result of the students or parents involvement in programs provided by Created By Kids LLC. The Parent/Guardian hereby accepts all risks involved with their child’s participation in creating art in a supervised workshop setting.
Please Select *

Agree Disagree
Registration will only be completed when Disclaimer is read and agreed upon. If you have any questions please contact us at rene@createdbykidsnyc.com. Thank you!
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After you click the submit button you will be redirected to the PAYPAL payment page.
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Street Address
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City	State / Province
Postal / Zip Code	Country

After-School Programs Registration & Payment Form

Lets get started!

Student's Information

Parent or Guardian Information

Emergency Contact Information

Additional Information

After-School Programs List & Payment