Enrichment Classes Registration Form – 2023

Child’s Name*

Parent Name*

Address*

City / State / Zip Code*

Cell Phone*

Email*

Emergency Contact Name

Emergency Contact Phone*

Date of Birth*

Food Allergies*

Name of School

How old will your child be on August 31st?*

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Traveling Tutor, LLC, Pre-K Academy, or Jill Leshin may use photos or video of your child and/or quotes from you or your child in The Traveling Tutor, LLC/Pre-K Academy/Ninja Minds 4 Kids publications, websites, and general media not to exclude advertisements or social media. I give the Pre-K Academy teachers permission to give my child NUT FREE food as it pertains to the lessons. Please list all food allergies above.

Signature of Parent/Guardian of Minor*

Date

In consideration of the services to be provided by The Traveling Tutor, LLC/Pre-K Academy/Ninja Minds 4 Kids on behalf of my child, myself, my heirs, personal representatives and assigns I do hereby release, waive, discharge, and covenant not to sue or bring a claim of any type against Traveling Tutor, LLC, its owners, officers, employees, agents and lessors from and against any liability for any and all claims including, without limitation, negligence or premises liability resulting in personal injury, accidents, illnesses or property loss arising from, but not limited to, my child’s participation in the services.

Signature of Parent/Guardian of Minor*

Date

$70 Per Month. $70 Materials Fee Charged at time of registration.
There are no refunds for missed days. Must give us 30-Days written notice to cancel your child’s spot.

Monthly Subscription - Enrichment Classes*

Price:

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Online Payment*

Card Details

Cardholder Name

Consent*

I give the PKA permission to text me pictures/video of my child.*

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Name

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