Smartycat Kids- Online Registration Form

Participant Information:

Child's Name:

Grade:

D.O.B:

Age:

Gender:

Phone:

Email:

Address:

Mother Cell:

Father Cell:

In the event of an emergency, please contact:

Name:

Phone:

Unusual Health/Medication Taken:

Additional Comments:

Program Information:

Session:

Fall

Spring

Winter

Summer/Camp

Class Location (Town/School/Other Location):

Class Time:

Day:

In registering my child for a Smartycat Kids program, I hereby give permission for my child
to participate in the activities provided by Smartycat Kids. I also hereby waive and
release any and all rights and claims for damages I or my child may have against
Smartycat Kids and its representatives, employees, agents, successors, and assigns for
any and all injuries suffered by my child during any activity sponsored by Smartycat Kids.
I understand that on occasion photographs may be taken during classes or camps for use
by Smartycat Kids in advertising or promotional material, and that children's names are
never used or posted.

I Accept

Parent Name:

Date:

Ready to sign your child up for one of our exciting Junior Scientists programs? Please take a
moment to fill out the following online registration form. When completed, please hit the "submit"
button at the bottom of the form, and your information will be sent to us to be processed. You will
receive a confirmation email that will include payment information and our mailing address for
checks. In our effort to keep our program fees as low as possible for parents and avoid any
additional processing fees, we are currently unable to accept credit cards or online payment at
this time. Please allow up to 24 hours for your confirmation email. Make sure to check your
spam box if you do not receive the confirmation email in your inbox within 24 hours.

Junior Scientists Online Registration Form