Please print this form and mail it along with a check (made out to The Happy Bookworm, Inc.):
The Happy Bookworm, Inc.
P.O. Box 376
Syosset, NY 11791
Class Location: ___________________________________________
Class Day: _____________________________
Class Time: ____________________________
Class Price: ____________________________
Child's Last Name _________________________________________
Child's First Name _________________________________________
Child's Birthdate __________________________________________
Address _________________________________________________
_________________________________________________________
Home Phone Number________________________________________
Emergency Contact Number __________________________________
Cell Phone Number__________________________________________
Mother's Name ____________________________________________
Father's Name _____________________________________________
Email Address _____________________________________________
Does your child have any allergies?
_________________________________________________________
If you are signing up with a friend, please write his/her name here:
________________________________________________________
Please choose one of the following and sign:
_____ I give permission for my child's photo to appear in the pamphlet or on the website for The Happy
Bookworm, Inc.
_____ I DO NOT give permission for my child's photo to appear in the pamphlet or on the website for The
Happy Bookworm, Inc.
___________________________________
Signature & Date
We will contact you by email or phone to let you know that we have received your registration and
payment.
The Happy Bookworm, Inc.
P.O. Box 376
Syosset, NY 11791
Class Location: ___________________________________________
Class Day: _____________________________
Class Time: ____________________________
Class Price: ____________________________
Child's Last Name _________________________________________
Child's First Name _________________________________________
Child's Birthdate __________________________________________
Address _________________________________________________
_________________________________________________________
Home Phone Number________________________________________
Emergency Contact Number __________________________________
Cell Phone Number__________________________________________
Mother's Name ____________________________________________
Father's Name _____________________________________________
Email Address _____________________________________________
Does your child have any allergies?
_________________________________________________________
If you are signing up with a friend, please write his/her name here:
________________________________________________________
Please choose one of the following and sign:
_____ I give permission for my child's photo to appear in the pamphlet or on the website for The Happy
Bookworm, Inc.
_____ I DO NOT give permission for my child's photo to appear in the pamphlet or on the website for The
Happy Bookworm, Inc.
___________________________________
Signature & Date
We will contact you by email or phone to let you know that we have received your registration and
payment.
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Policies:
1. Students will be
registered on a first come
first serve basis. Full
registration in order to
reserve your child's place in
class. Please mail your
registration and check for full
payment.
2. If for some reason you
need to cancel the session,
the following fees will apply.
There will be a $25
cancellation fee for canceling
prior to the first class. There
will be a $50 cancellation fee
for canceling prior to the
second class. There will be
no refund after the second
class.
3. The Happy Bookworm,
Inc. has the right to cancel
any class based on limited
enrollment. If a class is
canceled, all tuition and fees
will be refunded.
4. The accompanying adult
is solely responsible for the
safety of his or her child or
child committed to his or her
care while at The Happy
Bookworm, Inc. The Happy
Bookworm, Inc. and its
employees will be held
harmless for any accident or
injury to all adults and
children participating in
activities in The Happy
Bookworm, Inc.
1. Students will be
registered on a first come
first serve basis. Full
registration in order to
reserve your child's place in
class. Please mail your
registration and check for full
payment.
2. If for some reason you
need to cancel the session,
the following fees will apply.
There will be a $25
cancellation fee for canceling
prior to the first class. There
will be a $50 cancellation fee
for canceling prior to the
second class. There will be
no refund after the second
class.
3. The Happy Bookworm,
Inc. has the right to cancel
any class based on limited
enrollment. If a class is
canceled, all tuition and fees
will be refunded.
4. The accompanying adult
is solely responsible for the
safety of his or her child or
child committed to his or her
care while at The Happy
Bookworm, Inc. The Happy
Bookworm, Inc. and its
employees will be held
harmless for any accident or
injury to all adults and
children participating in
activities in The Happy
Bookworm, Inc.
| phone: (516) 521-5463 info@thehappybookworm.com |