KIDzKLUB Registration Form
 (One Form Per Child Please)

Name:

Address:

City:

Zip Code:

Phone:

Grade:

Name of School:

Parent's Names:

Do you attend a Church?
  (If yes, then enter name of church)

How did you hear about KIDzKLUB?
  (This will help us in our advertising of classes)

Course preference:

 (Please fill out all three choices!)

1st Choice:

2nd Choice:

3rd Choice:
Guidelines for KIDzKLUB:
All classes are offered on a first-come, first-served basis.  You can reserve a spot
by completing the form and paying the class fee, or requesting a scholarship if you
are unable to pay the fee.  If a class is full, your 2nd choice will be considered, and
then the 3rd.  Popular classes will be repeated.

Most classes have a minimum of five and a maximum of ten students to allow for
individual attention.  KIDzKLUB is open to all children in grades K-6.  No one
will be turned away due to financial hardship.

Special Note:  If a child is disrupting a class, the child will be warned.  However,
continued disruption will force that child to be stopped from attending further
classes.  A discipline policy is available upon request
 
   I have read the guidelines of KIDzKLUB and I give my child permission to
take the courses listed above.
 
I wish to apply for a scholarship.
 

Parent/Guardian Signature:

Please fill out and print this form.  The fee for each class is only $5.  Please return

the printed form and fee to the church office to complete your registration.