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          Registration Form

ONE REGISTRATION FORM PER CHILD (photocopies are accepted)

                                                        Click HERE for a PDF of the Registration Form

Child’s Name                                                                              Age                 Birthdate __/__/__

Parent / Guardian’s Name                                                                                                               

Address (street, city, zip)                                                                                                                

Home Phone                                                             Work Phone                                                   

Cell Phone                                                                  Alt. Phone                                                   

Email address (please print clearly)                                                                                                 

Emergency Contact Name                                                    Phone                                                 

How did you hear about us?                                                                                                           

Class Name

Dates

  Times

Fees

1

     $135.00

2

     

3

     

4

     

5

     

Before Care         ($5.00 per hour)                 Available from 7:00 - 9:00 AM

____ hours x $5.00

   

After Care           ($5.00 per hour)                 Available from 4:00 - 6:00 PM

  ____ hours x $5.00  

$

Total Fee                                            (Full balance due at registration)

(Please make checks payable to Jaicee Designs)

    

$

We gladly accept Visa/Mastercard for Summer Camp payment

Please call (425) 775-2035 for credit card payments.  Thank you.

By signing this registration form, the parent/guardian is giving permission for the registered child to attend all activities that the registered child has signed up for on Jaicee Designs campus and to be photographed while engaging in Jaicee Designs summer activities.  These photographs may be used for promotional purposes.

 

Full payment of your child’s total program fees is required at the time of registration.  Registration must be completed by June 15, 2010.  Checks made payable to Jaicee Designs, Inc.  Mail checks to:  Jaicee Designs, Inc.  24310  76th Avenue West  Edmonds, WA  98026. Credit cards are gladly accepted.

 

Refunds are given when we must cancel a class.  A class my be cancelled due to lack of enrollment.  The decision to cancel a class due to lack of enrollment is made after June 15, 2010.  Refunds are not given if and/or when a family’s plans change and your child may no longer participate in our summer program of classes.

The undersigned adult on behalf of themselves and their child agree to hold Jaicee Designs, Inc, it agents, employees, and officials while acting within the scope of their duties, harmless from all causes of actions, demands and claims, including the cost of their defense arising in favor of the child participant or third parties on account of personal injuries, death, or damage to property arising out of activities on the premises and in any way connected with the activities of the child participant in Jaicee Designs, Inc. Summer Program except for those acts of commissions which are the sole negligence of Jaicee Designs, Inc., its agents, employees and/or officials.

 

Parent/Guardian Signature                                                                            Date