registration form.

KIDVENTURES
APPLICATION
A summer enrichment program for children ages 3-6
Last Name
Gender
Male
First
Middle
Age
Female
Date
MUST BE TOILET
TRAINED
Home Address
Home Telephone
Other Telephone
City
State
ZIP
Full Name of Maternal Parent/Guardian
Best Contact Phone (circle one) home /work /cell
Full Name of Paternal Parent/Guardian
Best Contact Phone (circle one) home /work /cell
Parent Email Address
Emergency Contact
Phone #
Relationship
CLASS SELECTION (All classes take place from 10:30-11:30 am)
Select individual classes in the following grid by putting an X in the appropriate box:
You may choose a single class, a single week, a combination of these, or the entire program.
CLASS
MONDAY
MUSIC with Suzie Rozler
TUESDAY
YOGA with Brandi Silsby
Yoga poses and movements in
accordance with the week’s theme
WEDNESDAY
“LOOK AT BOOKS” with
Jennifer Anzalone
Themed story, craft & snack
THURSDAY
ART with Cassandra McFeely
WEEK 1
July 13-16
Insect-OMania
WEEK 2
July 20-23
Around the
World
WEEK 3
July 27-30
Race to
Space
WEEK 4
Aug 3-6
Sea Life
WEEK 5
Aug 10-13
The Circus
WEEK 6
Aug 17-20
Music to
My Ears
Next page 
PRICING*
SESSION
(1 per day)
$10
WEEK
(4 classes in each, 5% discount)
$38
PROGRAM
(6 weeks, 8% discount)
$220
* All participants incur a $5 registration fee as their entry into the KidVentures program. This fee is added to the cost of each
family’s selection of classes.
All payments and applications must be submitted to:
Kenan Center, 433 Locust Street, Lockport, NY 14094
ATTN: Heather Bowen
Checks made payable to: Kenan Center
WAIVER
I, the undersigned parent/guardian of _________________________________(child’s name), do hereby grant permission to
participate in any and all of the activities of the Kenan Center’s Whimsical Sculpture Project. I agree to be legally and
financially responsible, and agree to hold harmless the Kenan Center and its officers, agents and employees, from any and all
claims or actions arising against or in favor of my child or myself as a result of any act by, or event, occurrence, or accident,
happening to my child. I hereby give my permission for photographs and/or videos of my child to be used in promotional and
website materials in connection with this program and the Kenan Center.
Parent/Guardian Name (PRINT)
Signature
Date
ACCEPTANCE
There are a limited number of spaces available each week so parents are urged to apply as soon as possible. You will receive
notification prior to the start of the program confirming your child’s acceptance as well as further details on schedules,
classroom locations, and staff contacts.
If you have any questions regarding KidVentures or program pricing, or would like to pay program fees by credit card,
please call (716) 433-2617 or email [email protected].