Kaleidoscope Kids

Creative learning for children ages 3-13
July 3 - 28, 2017

 

Kaleidoscope 2017 Registration Form

This form may be filled out online or printed & faxed to (978) 475-1422.
To download a printable form, click here.

Please be sure to check the CLOSED COURSE list before submitting your registration.

Note: Please do not use the enter key when filling out this form.

1st Child Current Grade Age as of 6/1/17 (Yrs) (Mos)
2nd Child Current Grade Age as of 6/1/17 (Yrs) (Mos)
3rd Child Current Grade Age as of 6/1/17 (Yrs) (Mos)

Note: Current grade refers to child's grade in the 2016-2017 school year, not the grade he or she will be entering after the summer of 2017.

Parents' Names    
Please leave this field blank
Address
City State Zip
Email Address
Please retype Email Address

Home Phone  # Cell Phone #
Emergency Phone # Other contact #
Please leave this field blank

Course Information

Please use schedule when listing codes.

First Child's Course(s)

Code and Course Name
Please enter the code first
to ensure the correct course placement. Start typing and the course name will pop up. If you select the course once it pops up, the cost and fees will be filled in for you!
Course Cost Materials Fees
Check to enroll in KITE, July 31 - August 4

Second Child's Course(s)

Code and Course Name
Please enter the code first to ensure the correct course placement. Start typing and the course name will pop up. If you select the course once it pops up, the cost and fees will be filled in for you!
Course Cost Materials Fees
Check to enroll in KITE, July 31 - August 4

Third Child's Course(s)

Code and Course Name
Please enter the code first to ensure the correct course placement. Start typing and the course name will pop up. If you select the course once it pops up, the cost and fees will be filled in for you!
Course Cost Materials Fees
Check to enroll in KITE, July 31 - August 4

Description Quantity Amount
Registration Fee at $30 per family  
Total Cost of Courses  
Materials Fees
Early Bird (7:45-9:00) at $50 per week
Early Care (8-9) at $40 per week
Extended Day (2:30 - 5) at $110 per week
Late Care (5-6) at $75 per week
K.I.T.E. Tuition Fee ($405)  
Tax-Deductible Contribution  
Full-time 3-week Extended Day discount
(if applicable) $110
10% Third Child Discount
(applies to 3rd child only)
 
TOTAL  
Please indicate method of payment  
Pay now with credit card via Paypal
Payment will be mailed as a check in 24 hours or less
Comments

Emergency Consent Form

Child's Name Allergy
Child's Name Allergy
Child's Name Allergy


I, the undersigned parent or legal guardian of above named children will not hold Kaleidoscope, its agents, servants or employees responsible for any accidents incurred during participation in the Kaleidoscope program. If parents or doctor cannot be reached in case of emergency, consent is hereby given that the student receive medical treatment and/or surgical care as recommended by physician or hospital.

Parent Signature (required) Date

Your typed name is considered your signature



How did you hear about us?
 Website Word of Mouth  Brochure
 Advertisement Camp Fair   Other

Please click the submit button below to send your registration or print and then fax or mail this form.

If check is not mailed within 24 hours, registration cannot be confirmed.

Please make checks payable to KALEIDOSCOPE and mail directly to:
KALEIDOSCOPE
BOX 506
ANDOVER, MA 01810


Any questions?
Please call (978) 475-1422 days, nights and weekends and leave a message.

Print a copy of this form now for your records

Note: If you are using the PayPal option, please click submit first, then the PayPal link in the registration menu. A "0" will appear in the payment block when you get to the payment page. Please note your total before going to Paypal so that you can enter the amount that is due.