Bricks 4 Kidz Holiday Camp
Hi parents,

Thank you for signing up your kids to Bricks 4 Kidz Holiday Camp!
Kindly fill out this form to register.

Kemang Center Winter Camp 2018 Schedule
Parent's Name *
Your answer
Mobile Phone *
Your answer
Email *
Your answer
Student's Name *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
School *
Your answer
Holiday Camp Theme *
Your answer
Camp Date
Your answer
Voucher Code if any
Your answer
Authorized person to pick up my child from Bricks 4 Kidz. *
Required
Where do you live (ex. Kemang - Jakarta Selatan)
Your answer
Does the student has any allergies or medical condition? *
If you answered YES for allergies please kindly inform us what kind of allergy
Your answer
How do you know about us? *
Payment Method
Thank You for filling up this form, we will register your child and will contact you soon for further details or our WA number 0822.1888.0660
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