2017 – 18 SEASONREGISTRATION FORM

Participant Name: Age:

School:

Parent(s) Name: Day Phone:

Email (Mother): Email (Father):

Address:

City: Zip: Eve. Phone:

I accept full responsibility for my use of any and all apparatus, appliances, facility, privilege, or service whatsoever, owned and operated byDOODLE BUGZ KIDZ Co. at my own risk and shall hold DOODLE BUGZ KIDZ CO., it’s shareholders, directors, officers, employer’s representatives and agents harmless from any and all loss, claim, injury, damage or liability sustained or incurred by me resulting there from.

Signature: Date:

If participant is under 18 fill out this section:

In the event of an emergency, parents will be notified first. Please list additional contacts in case we are not able to notify the parents.

Emergency Contact Name: Phone:

In the event the parent(s) or persons named above cannot be reached during an emergency involving the above named participant, I give my permission to the DOODLE BUGZ KIDZ CO. staff to secure all necessary and required medical treatment. I give my full permission for my child(ren) to participate in the Doodle Bugz programs. The participant’s parent/guardian(s) agree that DOODLE BUGZ KIDZ CO. instructors, volunteers, and chaperones will not be held responsible for any accident or losses, however caused, and agree to release all parties involved from claim of damages that may arise as a result of or by reason of such loss or accident. I am of the understanding that every reasonable precaution will be taken to ensure the safety of the above named participant. I agree to pay for classes for each session, regardless of attendance, and my child will remain enrolled with fees due unless I inform the DOODLE BUGZ KIDZ Co. staff is writing that I would like to withdraw or make a change.

Parent/Guardian Signature: Date:

Please list any special needs, allergies, medication, learning disabilities or any other information we may need to make your child’s experience a positive one.

T-SHIRT ORDER INFORMATION: $18.00

SIZE:______CLASS: NAME:______

Child S / Child M / Child L / Child XL / Adult XS / Adult S / Adult M*This is the name you want on the shirt.

Payment Information

Online payment madeCheck #______

*Please make checks payable to: FRANCIOSI FITNESS PERFORMANCE CO.

c/o DOODLE BUGZ KIDZ CO.

13245 AQUAMARINE DR., CARMEL, IN 46033

$ Class(es) sub-total From back side of this form.

$ Add additional items ordered sub-total(*Additional items are optional)

$ Total amount enclosed

HOW TO REGISTER?

  • Complete appropriate sections on this registration form.
  • A separate registration form must be completed for each participant (child). Addtl registration forms can be found at your childcare facility.
  • Payment must accompany your registration form.
  • You may register in the following ways:

Drop registration at your childcare facility.

OR Register Online at:AVAILABLE – OCTOBER 2017

OR Mail Registration to: DOODLE BUGZ KIDZ in ACTION CO.

13245 Aquamarine Drive, Carmel, IN 46033

POLICIES

  1. We reserve the right to cancel programs with low enrollment. Low enrollment = 5 students or less.
  2. One-week advanced registration is required unless noted otherwise.
  3. Registration is accepted on a space available basis.
  4. If joining a session that has already begun, tuition fees will be prorated.
  5. Refunds cannot be given for programs cancelled by participants.
  6. Make-up classes are scheduled during the session class was missed. One class per session only please.
  7. Assume your registration is confirmed and the activity will meet as scheduled unless you are notified otherwise.
  8. To receive a mailed confirmation or receipt, please enclose a self-addressed stamped envelope.
  9. All students will remain enrolled with fees due unless 2-week written notification is provided to Doodle Bugz Kidz staff.
  10. Returned check charge $25.00 per check.
  11. All past due payments incur 1.5% interest charge.

USE THIS SECTION FOR DANCIN’ BUGZ COST: $48.00 (6 week sessions)
DANCEI: MONDAYS @ 9:30am
DANCE II: MONDAYS @ 10:30am (Offered if needed)
Day/Time you are registering: ______Class Location: Polly Panda
OPTIONALS:
Ordering T-Shirt for this class $18.00 TShirt Size: ______(XS 2T-3T, S4-6, M8-10, L12-14)
Ordering ballet shoes for this class $22.50 Shoe Size: ______(Use child’s street shoe size)

USE THIS SECTION FOR TUMBLE BUGZ COST: $48.00 (6 week sessions)

TUMBLE BUGZ II: TUESDAYS @ 9:30am (Ages 4+)

TUMBLE BUGZ I: TUESDAYS @ 10:30am (Ages 2 ½ - 4)

Day/Time you are registering: ______Class Location: Polly Panda

*All children will wear comfy clothes for class and tennis shoes.

Tumble Bugz I Kids are learning to stay with a group, beginning to understand & follow directions. Our lessons build on those concepts while introducing your child to physical activities that will engage their imagination while developing gross motor strength, coordination and early tumbling fundamentals.

Tumble Bugz II Kids will continue to focus on gross motor development (coordination, strength, spatial awareness & body control). Kids at this age are able to understand and follow multi-step instructions & are able to follow directions independently.

Both classes enjoy our exciting weekly themed curriculum based lesson plans as; Animalpalooza, Bubble Mania and Tumblin’ Bears, The Olympics.

OPTIONALS:

Ordering T-Shirt for this class $18.00 TShirt Size: ______(XS 2T-3T, S4-6, M8-10, L12-14)

**Please note: OurSpring Dance Recital June 5, 2018 which may require some addtl. costs for costumes.

Have a question?

Email: OR Call: 752-3657