Storybook Workshop -- Registration

Registration
Child's Name:
Parent's Name:
Child's Date of Birth:
Address:
Address 2:
Home Phone:		Cell Phone:
E-mail address:
Emergency contact:		Contact's Phone:
Please supply us with any information you feel is important for us to know about your child:
Please list any allergies or physical limitations:
Please list family members or friends who may pick your child up from class:
1.		2.
I have read and agree to the Storybook Workshop Refund Policy. I allow Storybook Workshop, LLC to use my child's picture in promotional materials.
INDEMNIFICATION AGREEMENT Recognizing and understanding that Storybook Workshop, LLC Classes are physical which could result in serious injury, the undersigned parent(s) / guardian(s) of understands and accepts his or her responsibility to provide for insurance to cover all personal injury and or property damage which may be incurred or recognizes and accepts that Storybook Workshop, LLC and Crawford Memorial United Methodist Church disclaims responsibility for any such personal injury and /or damage. Signed as a sealed instrument this day of Signature(s) of Parent(s) or guardian(s) _______________________________________________.
Please print, sign and send form, along with your tuition (payable to Storybook Workshop, LLC) to: Storybook Workshop c/o Tina Moran 5 Wildwood Terrace, Winchester, Ma. 01890
Class placement for office only: