Kindergarten Enrichment Program Registration

Mandatory fields are in red text

Please Complete the Following Form
Mother's Name
Father's Name
Participant Name
Date of Birth (mm/dd/yy)
School Name

Home Address
City
State	* Zip

Home Phone
Mom's Cell Phone
Mom's Work Phone
Dad's Cell Phone
Dad's Work Phone
Mom's Email Address
Dad's Email Address

Emergency Contact Name
Phone Number
Relationship

Emergency Contact 2 Name
Phone Number
Relationship

If installation payments are opted, the first payment is due on August 15th. The last payment will be due May 15th. Please note in our refund policy under FAQ's: There is no refund or adjustment for withdrawals or drops on the tuition for students that have registered and made a commitment to our classroom.
Additional forms disbursed by the teacher prior to the school year must be completed and turned in by the date specified for the timeline that is set forth by the Park District.
If transportation is to be provided it will be for District 101 students only.
Adjustments or refunds are not issued for a students who register and commit to this educational program *.

* Unless as a student is moved by the school district into an alternate program or leaves the Batavia School District

By selecting one of the items below I authorize the Batavia Park District to automatically charge my credit/debit card on file each for :
	One annual tuition payment of $2700 and a registration payment of $100 now.
	A registration payment of $100 and a monthly payment of $270. If I choose this option, I understand the withdrawal policy and agree that my credit card will be billed by the Batavia Park District on the 15th of every month August 2013 and ending with the last charge in May 2014.
	I understand with either option any delinquent payments will be automatically charged to my credit/debit card. I hereby give the Batavia Park District permission to charge my credit/debit card as indicated above, on either a one time or monthly basis for my child(ren's) 2013-2014 Kindergarten Enrichment Program payment.

WAIVER AND RELEASE OF PARTICIPATION: I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program/activity against the Batavia Park District, including its officials, agents, volunteers, and employees (hereinafter collectively referred as "Batavia Park District").

I do hereby fully release and forever discharge the Batavia Park District from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with this program/activity.

I have read and fully understand the above important information, that there is a warning of risk, assumption of risk and that this is a waiver and release of all claims. By registering on-line this shall substitute for and have the same legal effect as an original form signature.

» Download PDF Form