Creative learning for children ages 3-13
July 12 - 30, 2010

Kaleidoscope 2010 Registration Form

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

Payment must be mailed or paid via Paypal within 24 hours for registration to be confirmed.

If paying by check, please make payable to Kaleidoscope and send to:
Kaleidoscope PO Box 506 Andover, MA 01810.

1st Child Current Grade Age as of 6/1/10 (Yrs) (Mos)
2nd Child Current Grade Age as of 6/1/10 (Yrs) (Mos)

Note: Current grade refers to child's grade in the 2009-2010 school year, not the grade he or she will be entering after the summer of 2010.

Parents' Names    
Address        
City State Zip
Email Address Phone #
Emergency Phone Number    

Please use schedule when listing codes.

First Child's Course(s)

Code and Course Name
Please enter the code to ensure the correct course placement.

Second Child's Course(s)

Code and Course Name
Please enter the code to ensure the correct course placement.

Quantity Description Amount
Each course at $155
Adventures in Science ($335)
Musical Theater ($335)
Domino Physics ($335)
Marble Machine Madness ($325)
Materials Fees ($10 or $15 or $20)
  Registration fee at $30 per family
Early care at $30 per week
Extended day at $90 per week
Late care at $75 per week
Full-time program at $1095
KITE Tuition ($325)
Tax-deductible contribution (Applied to scholarships)
10% Third Child Discount (if applicable)
  Total

 I would like to receive future correspondence (June confirmation letter, etc.) via email. My address is:

Please indicate method of payment  
Pay now with credit card via Paypal
Payment will be mailed as a check in 24 hours or less

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

 
EMERGENCY CONSENT FORM
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.

Date
Parent's signature_____________________________________
Please check here if you agree to the terms stated in the online registration form
Child's Doctor
Doctor's Phone
You may provide comments or additional info below:


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

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