registration form.
KIDVENTURES APPLICATION A summer enrichment program for children ages 3-6 Last Name Gender Male First Middle Age Female Date MUST BE TOILET TRAINED Home Address Home Telephone Other Telephone City State ZIP Full Name of Maternal Parent/Guardian Best Contact Phone (circle one) home /work /cell Full Name of Paternal Parent/Guardian Best Contact Phone (circle one) home /work /cell Parent Email Address Emergency Contact Phone # Relationship CLASS SELECTION (All classes take place from 10:30-11:30 am) Select individual classes in the following grid by putting an X in the appropriate box: You may choose a single class, a single week, a combination of these, or the entire program. CLASS MONDAY MUSIC with Suzie Rozler TUESDAY YOGA with Brandi Silsby Yoga poses and movements in accordance with the week’s theme WEDNESDAY “LOOK AT BOOKS” with Jennifer Anzalone Themed story, craft & snack THURSDAY ART with Cassandra McFeely WEEK 1 July 13-16 Insect-OMania WEEK 2 July 20-23 Around the World WEEK 3 July 27-30 Race to Space WEEK 4 Aug 3-6 Sea Life WEEK 5 Aug 10-13 The Circus WEEK 6 Aug 17-20 Music to My Ears Next page PRICING* SESSION (1 per day) $10 WEEK (4 classes in each, 5% discount) $38 PROGRAM (6 weeks, 8% discount) $220 * All participants incur a $5 registration fee as their entry into the KidVentures program. This fee is added to the cost of each family’s selection of classes. All payments and applications must be submitted to: Kenan Center, 433 Locust Street, Lockport, NY 14094 ATTN: Heather Bowen Checks made payable to: Kenan Center WAIVER I, the undersigned parent/guardian of _________________________________(child’s name), do hereby grant permission to participate in any and all of the activities of the Kenan Center’s Whimsical Sculpture Project. I agree to be legally and financially responsible, and agree to hold harmless the Kenan Center and its officers, agents and employees, from any and all claims or actions arising against or in favor of my child or myself as a result of any act by, or event, occurrence, or accident, happening to my child. I hereby give my permission for photographs and/or videos of my child to be used in promotional and website materials in connection with this program and the Kenan Center. Parent/Guardian Name (PRINT) Signature Date ACCEPTANCE There are a limited number of spaces available each week so parents are urged to apply as soon as possible. You will receive notification prior to the start of the program confirming your child’s acceptance as well as further details on schedules, classroom locations, and staff contacts. If you have any questions regarding KidVentures or program pricing, or would like to pay program fees by credit card, please call (716) 433-2617 or email hbowen@kenancenter.org.
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