Friday Night Drop Off Feb 24 5:30-8:30
Ages 3-9, includes dinner
Child's Name
First Name
Last Name
Child's Age
Child's Date of Birth:
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Year
Do you need to register a second child for this particular class?
Yes
No
Second Child's Name
First Name
Last Name
Second Child's Age
Second Child's Date of Birth:
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January
February
March
April
May
June
July
August
September
October
November
December
Month
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1
2
3
4
5
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9
10
11
12
13
14
15
16
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18
19
20
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22
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25
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28
29
30
31
Day
Please select a year
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2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
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2002
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1982
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1953
1952
1951
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1949
1948
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1945
1944
1943
1942
1941
1940
1939
1938
1937
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1935
1934
1933
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1930
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1928
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1925
1924
1923
1922
1921
1920
Year
Parents' Names
Address
City
State
Zip
Home Phone:
Cell Phone:
Email:
Emergency Contact:
Emergency Contact Phone:
How did you hear about Kidzfun?
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Friend
School
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Waiver Forms
As parent/guardian, I hereby release, hold harmless and indemnify Theresa McLennan KIDZFUN and Pedros Judo Center from any and all lost, claim, damage, or injury of any kind whatsoever which may occor as a result of my use of the facilities located at Pedros Judo Center, 19 New Salem St., Wakefield, MA. I understand and acknowledge that said release shall include all injury or damage of any kind whatsover whether to person, property, or otherwise. By checking Yes, I certify that I agree with these terms.
*
Yes
No
I hereby give permission for images of my child/children, captured during regular and special Kidzfun activities through video, photo and digital camera, to be used soley for the purposes of Kidzfun promotional material, publications, and newspaper releases and waive any rights or compensation or ownership thereto. I understand that my child's name will not be used without my permission. By checking Yes, I certify that I agree with these terms.
*
Yes
No
Please sign (using the computer mouse or your finger if using a tablet/phone):
*
Payment Options
Please Select
Will pay online
Will mail a check
Friday Night Drop Off
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One child
$
35.00
Additional Child
$
35.00
Total
$
0.00
Checks can be made payable to Kidzfun and mailed to Theresa McLennan, 23 Spring St, Saugus, MA 01906
Submit Form
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