KENTWOOD AFTER SCHOOL ENRICHMENT APPLICATION FALL 2009

Contact Information:

Child’s Name: Teacher:

Parent’s Name: Cell Phone:

Address: Home Phone:

Emergency Contact: Emergency Phone:

Class Selection: Notes or Special Requests:

$105.00
Abrakadoodle
$265.00
Broadway Gymnastics
$200.00
Do Re Mi (Keyboards I & II/Guitar I&II/Garageband)
$50.00
Guitar Rental
$250.00
Do Re Mi (Garage Percussion Class)
$150.00
Language Door (Mandarin/French/Spanish)
$125.00
Kids On Stage
$79.00
Mad Science
$125.00
Digital Storytelling

$150.00
Math Enrichment Program

$150.00
Beginning Violin and Cello
$175.00
Kinderfiddle Preparatory Music Academy

Total:

I, we, the parent(s) or guardian(s) request that the applicant below be enrolled in after school enrichment programs to be conducted at
Kentwood Elementary School, hereinafter referred to as the “School” and in consideration of the School’s acceptance of my/our request
as above noted, I/we hereby agree to waive any damages or claim whatsoever that I/we may have against the School, its members,
agents, directors, or servants, as a consequence of any injury to the above named applicant, howsoever caused, while participating in
any form of the above named activities sponsored by the School.
Parent Signature: Date: