Build, Read & Sense Program - Celebrate Life Studio

Grow your child's love of learning along with their creativity, motor skills and social skills in our interactive CTD social hour! Activities for ages 12 months- 45 months old from 9-10AM.

Please register and pay at least one hour before each class.

Every Wednesday from April 1 to May 27 at Celebrate Life Studio:
1200 Park Ave., Hoboken, NJ 07030

ctdtherapy.com

admin@ctdtherapy.com

Date of Class

Child's Information

#1 Child's Name

First NameLast Name

Birth Date

MonthDayYear

Child's Name

First NameLast Name

Birth Date

MonthDayYear

#2 Child's Name

First NameLast Name

Birth Date

MonthDayYear

Parent/Guardian Information

Name

First NameLast Name

Cell Number

Area CodePhone Number

E-mail

example@example.com

We may contact you in the future using your email address. We value your privacy. Please refer to our Electronic Communication Privacy Policy which can be found on our website: ctdtherapy.com. Do we have your permission?

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Do we have your permission to use photos and videos taken of your family for publicity purposes? Names will never be used in social media marketing.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by CTD OT during the selected class. In exchange for the acceptance of said child’s candidacy by CTD OT, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless CTD OT LLC and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participating in selected class.

In case of injury to said child, I hereby waive all claims against, including all staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in any class.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

My Products

Build, Read, & Sense Hour (Drop-In)$20.00

Quantity
Item subtotal:$0.00

Build, Read, & Sense Full Program$150.00

Quantity

Total $0.00

Credit Card

Build, Read & Sense!

Credit Card