February Blast 2017
Ages 3-8
Child's Name
First Name
Last Name
Child's Age
Child's Date of Birth:
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January
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Month
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Day
Please select a year
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Year
Please select the day(s) this child will attend:
Tuesday, February 21st
Wednesday, February 22nd
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:
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
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1996
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1994
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1992
1991
1990
1989
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1982
1981
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1952
1951
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1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Please select the day(s) the second child will attend:
Tuesday, February 21st
Wednesday, February 22nd
Thursday, February 23rd
Parents' Names
Address
City
State
Zip
Home Phone:
Cell Phone:
Email:
Emergency Contact:
Emergency Contact Phone:
How did you hear about Kidzfun?
Please Select
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 and/or Reading Athletic Club 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 and/or Reading Athletic Club, 1 General Way, Reading, 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
February Vacation Camps
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( X )
1 Day Camp (Cost per child)
$
25.00
Number of Children
2 Days of Camp (Cost per child)
$
45.00
Number of Children
3 Days of Camp (Cost per child)
$
65.00
Number of Children
Total
$
0.00
Checks can be made payable to Kidzfun and mailed to Theresa McLennan, 23 Spring St, Saugus, MA 01906
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