asaekids

We'll handle the kid stuff.	Children's Program Registration Form - ASAE & The Center for Association Leadership - August 21-24, 2010

There are two ways you can register for the children's program:
1. Complete and submit the online form listed below.
2. Download the Adobe Acrobat version of this form to mail or fax to us, click here:
Acrobat Version of Registration Form.
It is not necessary to do both.

Where, When, For Whom

The children's program is for children ages 6 months through 17 years old and will be located at the JW Marriott in Los Angeles. Snacks and beverages will be provided. Meals need to be supplied by parents.

Medication will NOT be administered by KiddieCorp. Be sure to fill out the following form COMPLETELY. To ensure a safe and fun-filled environment, any child who is ill will not be admitted to the children's program.

The cost for the children's program is $10.00 per hour, per child (2-hour minimum required per child, per day).

The advance registration deadline is August 1, 2010. Register early as availability is limited and handled on a first-come, first-served basis. This form must be completed in its entirety and payment received before registration is confirmed.

Cancellations must be made to KiddieCorp prior to August 1, 2010 for a full refund. Cancellations made after that date will be subject to a 50% cancellation fee. Once the program has begun, no refunds will be issued.

Parent Information:

Parent Name(s):

Home Phone:

Work Phone:

E-mail Address:

Full Mailing Address:

Check here if your child(ren) has/have any special needs under the Americans with Disabilities Act. We will contact you so that we may make appropriate arrangements to accommodate your child. Please provide details in the box below.

Check here if any of your children have health limitations or special needs. Please let us know so that we may ensure your child(ren)'s needs are met. Please provide details in the box below.

Child(ren)'s Names and Ages:

1. Name: Age:

2. Name: Age:

3. Name: Age:

4. Name: Age:

5. Name: Age:

Dates & Times:

Saturday, August 21 -- 5:00pm to 9:30pm

Drop-off Time: pm Pick-up Time: pm

Sunday, August 22 -- 8:00am to 5:00pm

Drop-off Time: am pm Pick-up Time: am pm

Sunday, August 22-- 5:00pm to 10:00pm

Drop-off Time: pm Pick-up Time: pm

Monday, August 23 -- 8:00am to 5:00pm

Drop-off Time: am pm Pick-up Time: am pm

Monday, August 23 -- 5:00pm to 10:00pm

Drop-off Time: pm Pick-up Time: pm

Tuesday, August 24-- 8:00am to 5:00pm

Drop-off Time: am pm Pick-up Time: am pm

Tuesday, August 24 -- 5:00pm to 10:00pm

Drop-off Time: pm Pick-up Time: pm

Please feel free to provide additional details or special instructions in the box below.

Payment in full is required to confirm your reservations. Although every effort will be made to accommodate late or on-site registrations, there is no guarantee that KiddieCorp can accept children unless they are pre-registered. Please make sure to bring a photo I.D. with you to the children's program. A photo I.D. will be required for check-in and check-out of children. We will have you complete a consent form when you arrive at the children's program.

Calculating Fees & Payment Options:

*$10.00 per hour per child X # of Children X # of Hours =**

*Children must be registered for a minimum of two consecutive hours per child, per day.

KiddieCorp accepts checks and money orders (drawn on a U.S. Bank in U.S. dollars), MasterCard, Visa and American Express.

If you are paying by credit card, please enter your card number and print a copy of this completed registration form for your records BEFORE you submit on-line. If you prefer, you may fax the form to (858) 455-5841.

Credit Card Number: Expiration Date:

Check here if you are paying by check.

If you are paying by check, please print two copies of this completed registration form. Keep one copy for your records and mail the other copy along with your check or money order to:

KiddieCorp/ASAE
8961 Complex Drive
San Diego, CA 92123
(858) 455-1718