Summer Group

Child's Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Child's Mother /Guardian 1

First NameLast Name
Home Tel:

Area CodePhone Number
Cell:

Area CodePhone Number
Primary E-mail
Child's Father/ Guardian 2:

First NameLast Name
Home tel:

Area CodePhone Number
Cell:

Area CodePhone Number
E-mail
Parent(s)/Guardian(s) are:

MarriedSingleSeperatedDivorcedWidowedGrandparents
Policies

Please initial each section once you have read over and agree to terms and conditions
Registration:

Each form must be accompanied by a deposit of $150.00. Classes are subject to cancelation based upon enrollment. If you have paid you will be reimbursed if the class is canceled due to enrollement. You can choose to pay by check, cash, zelle or via paypal. The class must be paid in full by the first class.
Initial
Permission:

I give permission to use photographs of my child for promotional purposes
Inital
Health:

I understand that it is my responsibility to consult a physician regarding my child’s participation in all programs offered by The Kidz Lounge prior to attending. I believe that my child is in good health and in proper physical condition to participate in such activities. I understand that it is my responsibility to inform The Kidz Lounge, of any injuries and/or limitations that might affect their ability to participate in a registered class.
Initial
Does your child have any allergies?

yesno
If yes to above please explain
What to where:

Children should wear light weight comfortable clothing that allows them to move easily.
Attendance Policy:

Make-up classes are only offered if the class is cancelled by the instructor. No make- ups for missed sessions.
Initial
Refund Policy:

The Kidz Lounge guarantees a refund prior to the start of the first class of the session, minus the registration fee. You must notify The Kidz Lounge 5 days prior to the start of the session. No refunds thereafter.
Initial
Cancellations:

"The Kidz Lounge"reserves the right to cancel a class due to low enrollment. In the event this happens, you may choose a different class, or receive a complete refund. The Kidz Lounge has sole discretion to determine if a class should be canceled due to weather. We will attempt to contact you via your preferred method in the event a class is called off due to weather. In addition, a notice will be left on the answering machine and posted to our website and Facebook page. In the case of a cancellation due to weather, a make up class will be scheduled. In the rare instance an instructor must cancel a class due to illness/emergency, a make up class will be scheduled.
Initial
Release of Liability Waiver
I,

First NameLast Name
,______________________________________, being over the age of eighteen and parent or legal guardian of
First NameLast Name
In consideration of the services to be provided by The Kidz Lounge, hereby release and discharge The Kidz Lounge, its officers, owners, and employees as follows:
1. I understand that these activities may involve physical movements.
1. As in the case with any physical activity, the risk of physical injury, whether minor or serious and disabling, cannot be entirely eliminated. I know of no physical or mental condition that would prevent my child from participating in activities, exercises, or instruction. I will inform the instructor of any health or mental conditions that may prevent my child from safe participation.
1. The Kidz Lounge group classes are not a substitution for medical attention, examination, diagnosis or treatment. Some activities are not recommended and are not safe under certain medical conditions. I understand that I alone am responsible for keeping the instructor informed of my child’s health needs and deciding if he/she should continue with the class.
1. I have fully read this Release of Liability Waiver Form carefully. I voluntarily give up certain legal rights and possible claims, demands, and rights of action which are or may be related to or arise out of my child’s participation, and omission, acts or negligence of any sort.
Child's full name

First NameLast Name
Date

MonthDayYear
Parent's name

First NameLast Name
Parent's Name:
Summer Group

Reserve Spot with deposit: $150.00

Program Fee: $1200 for 4 week cycle

4 days per week- for 4 weeks

Payments Must be Made in Full by the First Session

Discounts offered:

$50 off if registered by 6/15

10% sibling discount

Schedule:

Time: 9:30 am-11:00 am for ALL WEEKS

Cycle 1

June 30th-July 24th

Mon-Thursday NO FRIDAYS

Cycle 2

July 28th-August 21st

Mon-Thurs NO FRIDAYS

NO MAKEUPS ARE GIVEN FOR MISSED SESSIONS

Please make checks payable to: The Kidz Lounge

Mail to: The Kidz Lounge

8212 151st Ave. Howard Beach, NY 11414
OR

We also except Pay Pal, Check, Cash or Zelle

If using Zelle please send payment to thekidzloungeny@gmail.com
Class Registering for

Cycle 1: June 30th-July 24thCycle 2: July 28th-August 21stCycle 1 & Cycle 2

My Products

Deposit ONLY $150.00

Cycle 1- IN FULL$1,200.00

Cycle 2- IN FULL$1,200.00

Enter coupon

Total $0.00

Should be Empty:

Policies

Release of Liability Waiver