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Adventure Kids September 2025 Registration Form
Mon - Thurs 3:15 - 4:45
Coordinator: Ms. Nichols
$7.00 per day. Second sibling only $5.00
No Refunds unless school is cancelled
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* Indicates required question
Student
*
Your answer
Grade
*
Your answer
Teacher
*
Your answer
Sibling Name
Your answer
Sibling Grade
Your answer
Sibling Teacher
Your answer
Dates Attending
First Child
Sibling
Monday Sept 8
Tuesday Sept 9
Wednesday Sept 10
Thursday Sept 11
Monday Sept 15
Tuesday Sept 16
Wednesday Sept 17
Thursday Sept 18
Monday Sept 22
Tuesday Sept 23
Wednesday Sept 24
Thursday Sept 25
Monday Sept 29
Tuesday Sept 30
Wednesday Oct 1
Thursday Oct 2
First Child
Sibling
Monday Sept 8
Tuesday Sept 9
Wednesday Sept 10
Thursday Sept 11
Monday Sept 15
Tuesday Sept 16
Wednesday Sept 17
Thursday Sept 18
Monday Sept 22
Tuesday Sept 23
Wednesday Sept 24
Thursday Sept 25
Monday Sept 29
Tuesday Sept 30
Wednesday Oct 1
Thursday Oct 2
Amount Due
*
Your answer
Parent
*
Your answer
Cell Phone # and Home #
*
Your answer
email address
*
Your answer
Street Address
*
Your answer
Mailing Address
*
Your answer
During the program I can be reached at
*
Your answer
Emergency Contact
*
Your answer
Emergency Contact Phone #
*
Your answer
Relationship
*
Your answer
CHILD WILL GO HOME BY
*
Late Bus
Parent Pick Up
Pick Up Name
Your answer
Allergies
Your answer
Payment Type
*
Sending cash or check in tomorrow. Check Payable to Bartlett Recreation Department
Invoice me and I will pay by credit card (Square fee applies)
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