SuperStar Saturday Registration Form

Cra-Z-Dreams SuperStar Saturday

Registration Form

(ages 13 to 18)

Cra-Z-Dreams Life Skills Development LLC
Child Information
Name*

First NameLast Name
Age*
Grade*
School Attending*
Guardian / Parents Names*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guardian's Cell Phone*

Area CodePhone Number
Teen's Phone (Optional)

Area CodePhone Number
Guardian's E-mail*
Teen's E-mail (Optional)
Desired Package - Pay by Phone (enter # sessions > 10 or discount codes under "Other"). Cra-Z-Dreams will contact you to confirm your order and process payment:

Platinum (10+ sessions) ---> $175+Gold (8 sessions) ---> $160Silver (6 sessions) ---> $135Bronze (4 sessions) ---> $100Platinum Additional Sessions (# sessions > 10) ---> $17.50One Day Intro Workshop (2 hours) ---> $50.00Other
Please select any other programs you might be interested in below. Additional information on these programs is available at Cra-Z-Dreams.com.

Creative Expressions: Word Warriors (Ages 11-17. Every 3rd Saturday 2-4pm)Girls' L.Y.F. : Love Yourself First! (Girls 11-17. Every 3rd Saturday 2-4pm)Boys' L.Y.F. : Building Men from the Inside Out (Boys 11-17. Every 4th Saturday 2-4pm)G.R.E.A.T. S.T.A.R.T. 2-day Crash Course (Ages 11-17. Two 3 hour workshops.)DestinMe Purpose/Career Planning (Ages 11-17. One 2 hour workshop.)Life-onomics: Making Dollar Decisions (Ages 11-17. One 2 hour workshop.)Vision 4 Life Vision Board (Ages 11-17. One 2 hour workshop.)Social Media Management (Ages 11-17. One 2 hour workshop.)Professional Skills (Ages 11-17. One 2 hour workshop.)Individual Life Coaching Session (Ages 11-17. Contact Director to schedule desired # of sessions.)Basketball (Ages 5-17. Contact Director to schedule desired # of sessions.)Tennis (Ages 5-17. Contact Director to schedule desired # of sessions.)
Please explain your interest in the above programs for your child or group. Also, enter any growth areas that should be points of focus for your child along with his/her strengths. (Send an email to info@cra-z-dreams.com with child's name if you run out of space)
Important Notes

· Dress appropriately (school appropriate attire -- see our guide).

· Keep the classroom/practice area/facility clean.

· Be courteous and respectful to everyone we encounter.

. No food or drinks in classroom/gym, but those might be sold outside of the classroom/gym for participants and others.

. All members and parents are expected to demonstrate proper respect to teachers, coaches, special guests and other members/students. Cra-Z-Dreams reserves the right to release any member(s) for conduct by him/her or their parent(s) deemed inappropriate or detrimental to the program. We are here to develop character and life skills for each child and maximize the growth of each individual.
Emergency Contact & Health Insurance Information
Emergency Contact's Name (if different from above)

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Does the child you are registering have health insurance?

YesNo
Insurance Carrier
Name of Policy Holder
Subscriber ID
Group Number
Card Number / Card Date
Does the participating child have any allergies, chronic illness, or medical conditions?*

YesNo
Please describe*
Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Parent/Guardian's Signature*
Relationship to Child*
Should be Empty: