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Parent/Guardian Name
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Address (street, town, zip)
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Your email address:
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Phone Number: Home
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Phone Number: Cell
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Participants Name
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Date of Birth
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Grade
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Photos taken at this program may be used for promotional purposes.
Please check here only if you do NOT want pictures published.
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By hitting "Submit", I agree to hold Ct Kids on Stage, any person connected therewith, its
employees, members and those associated with this program harmless from any and all claims
for bodily injury, negligence and property damage arising from my child‘s (children's)
participation in this activity.
In addition, I understand that refunds will only be made if the class and the make-up class are
cancelled due to weather. The make-up class will be ????????.
Participants should wear comfortable clothing and bring a lunch/snack and water.
Registration will not be complete until payment is made. Paypal (no account necessary) is
available for your convenience.
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I will pay now using PayPal.
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I will mail my check payable to: Maureen Alfiero, 18 Reservoir Road,
Killingworth, CT 06419
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Please use your browsers Back Button after hitting
"Submit" to return to this page.
Thank you for registering. We look
forward to meeting you.
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