Habonim Registration

Registration Form
PLEASE NOTE: Current classes on offer are for 15 -23 month olds (Kinderdance With Me) and 2 Year Olds (Kindertots)

* Indicates required field

Parent's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Email *

Secondary Email *

Phone Number *

Child's Name (Please note: If registering more than one child you will need to fill out a separate registration form for each child) *

First

Last

School Name *

Classroom name (example: Toddlers, PK3, Home *

Gender *

Female Male

Select Program *

Monday Kindertots 9:00 Monday Kinderdance With Me 9:30

Emergency Contact *

First

Last

Emergency Phone Number *

I have read and agree to all policies, terms and conditions, as outlined in the Policies page of the Kinderdance® Manhattan and the Bronx website. *

Yes

Click here for Policies Page

I realize that any program such as Kinderdance® and its affiliated programs which involve movement and motion can result in physical injury. I permit my child to participate in Kinderdance® and release Kinderdance® International or local Kinderdance® franchisees from all liability for injury to my child from his/her participation in this program. Furthermore I agree to allow Kinderdance® International or local Kinderdance® franchisees to use photographs and/or video of my child for Kinderdance® web-sites and promotional purposes without compensation to my child or myself. I have read and agree to this liability waiver. *

Yes

Payment

First semester Kinderdance With Me and Kindertots classes at Habonim start on Nov 7, 2016 and cost $170 for 11 classes

Parents can pay two ways:
1. Mail a check made out to Kinderdance and send with a printed registration form to:
Kinderdance
645 West End Ave #1F
New York, NY 10025

2. Pay online via Chase Quickpay.
You do NOT need to have an account with Chase to use this service
My recipient email is KinderdanceNYC@aol.com
Totally safe, neither of us will see any account information.
Click here to enroll in Chase Quickpay

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