Kangaroo Club - Registration Form for Preview Classes

Child's Name:
Child's Gender: femalemale
Birth Date:
Name of adult accompanying child:
Parent(s) Name(s):
Address:
City:
State:
Zip Code:
Home Telephone:
Work/Cell:
Email address:
First Name and ages of siblings:
List any medical/behavioral issue the Kindermusik educator should be aware of:
How did you hear about us?:
Class choices. Select all that apply.
Family Time Preview - Sat 12/04/10 9:15am
Family Time Preview - Mon 12/06/10 10:15am
By submiting this form I release any and all rights and claims for damages against Kangaroo Club LLC, and its staff in the unlikely event of injury sustained by myself or my child during the course of, or as a result of this activity.

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