Summer Group

Summer Group
Child's Name

First Name Last Name
Birth Date

Month Day Year Date Picker Icon
Gender
Child's Mother /Guardian 1

First Name Last Name
Home Tel:

Area Code Phone Number
Cell:

Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Work Tel:

Area Code Phone Number
E-mail
Child's Father/ Guardian 2:

First Name Last Name
Home tel:

Area Code Phone Number
Cell:

Area Code Phone Number
Work tel:

Area Code Phone Number
E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent(s)/Guardian(s) are:

Married Single Seperated Divorced Widowed Grandparents
Other relatives with permission to bring your child to class:

First Name Last Name
Relationship to child:
Phone Number

Area Code Phone Number
Policies

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

Each form must be accompanied by a registration fee and/or deposit. Classes are subject to cancelation based upon enrollment. If you have paid you will be reimbuirsed if the class is canceled due to enrollement. You can choose to pay by check or credit card 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
What to bring/Attire:

Children should wear light weight comfortable clothing that allows them to move easily. If registering for a yoga class, yoga mats are available for use during the class, it is encouraged that your child bring their own yoga mat.
Initial
Attendance Policy:

Make-up classes are only offered if the class is cancelled by the instructor. No make- ups for missed sessions. Due to space, please only one parent per child. We also ask that you do not bring siblings to the classes.
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
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
Food and Drinks:

There may or may not be a designated snack time in which you can provide your child with a snack. All food must be given at designated area. No food or drink will be allowed during other class times. Snacks must be peanut free.
Initial
Initial
Release of Liability Waiver
I,

First Name Last Name
,______________________________________, being over the age of eighteen and parent or legal guardian of
First Name Last Name
in consideration of the services to be provided by The Language Lounge and Confident Kidz (ref to as 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 Name Last Name
Date

Month Day Year Date Picker Icon
Parent's cell:

Area Code Phone Number
Parent's name

First Name Last Name
Parent's Signature:
Summer Group

Reserve Spot with deposit: $100.00

Program Fee: $175 per week session

All Materials Included !!

Payments Must be Made in Full by the First Session

Discounts offered:

10% discount if child signs up for 1+ weeks AFTER

first week is PAID IN FULL

10% sibling discount

Schedule:

Time: 9 am-11 am for ALL WEEKS

Week 1: July 9th & July 11th

Week 2: July 16th & July 18th

Week 3: July 23rd & July 25th

Week 4: July 30th & August 1st

Week 5: August 13 & August 15 th

NO MAKEUPS ARE GIVEN FOR MISSED SESSIONS

Please make checks payable to: The Kidz Lounge

Mail to: The Kidz Lounge

158-01 Crossbay Blvd. Howard Beach, NY 11414
OR

(Cash is also accepted if dropping off )
Class Registering for :

Week 1 Exploring Ocean Animals Week 2 Circus in the Sand Week 3 Beach Olympics Week 4 Camping by the Seashore Week 5 Luau
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Summer Group

Policies

Release of Liability Waiver