Form

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 *
Will your child be part of a group pick up? *

YES NO
PICK UP INFO
Teachers Name and childs place of dismissal
Do you have a sibling who will be joining you during a CBK class? *

YES NO
Sibling's Name

First Name Last Name
Grade
School they attend
PICK UP INFO (siblings must be from the same school for pick up)
Teachers Name and childs place of dismissal
Date of Birth
Gender
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

YOU MUST CHOOSE A QUANTITY FOR THE CLASS YOU ARE REGISTERING FOR CHECK YOUR TOTAL BEFORE SUBMISSION

Classes *

Illustration (Mondays | Sept. 17 - Dec 17)

FALL 2018	Price	Quantity
12 classes	$ 480.00
12 classes \| with subway fee	$ 505.00

3D Design & Sculpture (Tuesdays | Sept. 18 - Dec. 18)

FALL 2018	Price	Quantity
13 classes	$ 520.00
13 classes \| with subway fee	$ 545.00

Stop Motion Animation (Wednesdays | Sept. 26 - Dec. 19)

FALL 2018	Price	Quantity
13 classes	$ 520.00
13 classes \| with subway fee	$ 545.00

Ceramics & Pottery Wheel (Thursdays| Sept. 20 - Dec. 20)

subway fee is only for schools where walk over is not available	Price	Quantity
13 classes	$ 520.00
13 classes \| with subway fee	$ 545.00

Fashion Design & Sewing (Fridays| Sept. 21 - Dec. 21)

FALL 2018	Price	Quantity
13 classes	$ 520.00
13 classes \| with subway fee	$ 545.00

Enter coupon

Total $ 0.00

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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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