Registration

Register for 2017 Xiao Mao Little CATS Asian Summer Camp HERE!

Summer Camp Registration Form

Child's Name *

Age * 8 9 10 11 12

Date of Birth *

mm/dd/yyyy format (i.e. 10/25/2003)

Grade * 2 3 4 5 6 7

Special Needs or Allergies?

Parent (or Guardian) *

Address *

City, State, ZIP *

Home Phone *

Day/Work Phone

Email *

Required for confirmation

Cell Phone

Permission *

By checking this box: I, being the natural/legal parent/guardian of the child named in this registration form do hereby give and grant my permission to Xiao Mao Culture Club for said child to participate in the Summer Culture Camp.

Release of Liability *

By checking this box: I, my heirs, and assigns, do hereby release and discharge the Xiao Mao Culture Club from any liability, claim, or cause of action that I may now have or may have in the future as a result of any injuries received by the said child while s/he participates in the class.

I understand that the Xiao Mao Culture Club uses photos/videos on its website and/or for program-related publicity (flyers, posters, student keepsake books, and DVDs.) I also understand that the club will never identify any children by name. *

I authorize the Xiao Mao Culture Club to use photos/videos that my child/ren appear in.

I do not authorize the Xiao Mao Culture Club to use photos/videos that my child/ren appear in.

Future email from Xiao Mao Club? *

Please email me information on future events and classes

No thank you

Payment/Invoice Option *

Send me an email confirmation with a link to pay using Pay Pal or a Credit Card (can take up to 48 hours)

Send me an email confirmation with a printable PDF to mail in a check

Send me an email confirmation with a printable PDF to bring on the first day of the seesion (This option is reserved for previously registered families)

Please tell us how you heard about this program and any Coupon Codes