PROGRAM REGISTRATION FORM

Please enroll my child or me in the following program(s).

**don't forget to fill out the information section below**


Select season
Select Weekday


Select Weekday


Select Weekday:

Select Age Group
Select Holiday


Select Week




Select Week

Please complete registration below. To pay, please contact Amy Bisignani at (914) 834-1443 or scheduling@sheldrakecenter.org. The reservation is not complete without payment.

Adult Contact Information

                   
        
       
                    
                

Child #1

                   
        
       
                       
               
    
        
      
        

Child #2

                   
        
       
                       
               
    
        
      
        

Permission to seek treatment
I give permission, in case of a medical emergency, to take my child to a hospital for treatment, to include evaluation of injuries, x-rays and needed care.

                

Permission to use photographs of my child in Sheldrake publicity
I give permission to use photographs of my child for publicity, website and newsletters.

                


Payment must be received upon registration in order to reserve a space for your child. 50% of fee is refundable with more than 2 weeks notice.
 
   
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