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| *Child's Name: |
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| *Child's Birth Date: |
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| 2nd Child: |
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| 2nd Child's Birth Date: |
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| 3rd Child: |
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| 3rd Child's Birth Date: |
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| *Parent(s) First and Last Name: |
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| *Adult Attending Class: |
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| *Address: |
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| *City, State, Zip Code: |
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| *Email address: |
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| *Phone Number: |
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| *1st Class Choice:(view schedule) |
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| *2nd Class Choice:(view schedule) |
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| Purchasing a Drop in Class? Choose a Date: |
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*Space will be available on a first-come first-served basis. We will make every attempt to give you your first choice but please put down a second choice. Class placement will be confirmed via email. Westfield and Livingston Classes are being held by Creative Kids please visit their website www.creativekidsnj.com for details. |
Please let us know how you heard about us or send us a note:
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*PARENT OR GUARDIAN, PLEASE READ THE FOLLOWING AND CHECK BELOW:
I agree to assume responsibility for my child or children and myself and/or caregiver when upon the premises operated by Preschool of Rock, Preschool of Rock employees and Michael Napolitano, Whats The Scoop, Creative Kids, Work it Out, and will hold harmless Preschool of Rock, Preschool of Rock employees and Michael Napolitano, Whats The Scoop, Creative Kids, Work it Out, and any of its employees and/or agents in the event of any personal injury, property damage or loss, indemnifying said parties of any loss that I might incur as a result. |
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