summer 2012 2012

Date:_________________ Date: _______________ Name: __________________________________________ Childs Name: ___________________________________________ Age:______________Birth Date: ___________________________ Age: ______________ Birth Date: __________________________ Sex: Male Female Sex: your child have any allergies? ___________________________ Male Female Does Mothers Name: _________________________________________ Does your child have any allergies?: __________________________ Fathers Name: __________________________________________ Mothers Name: _________________________________________ Address: _______________________________________________ Fathers Name: __________________________________________ City:_____________________State:_______Zip: ______________ Parent Email Address (required): ____________________________ Address: _______________________________________________ Mobile Phone: __________________________________________ City: ____________________ State: _______ Zip: _____________ Emergency Contact: Name: Email Address (required): ____________________________ Parent ________________________________________________ Phone: ________________________________________________ Mobile Phone: __________________________________________
June 5th, 6th & 7th Rumble in the us to faraway Jungle Expedition will take Our Jungle Expedition will take Jungle: Our lands where well find wild us animals of every kind. With our own Safari Vests and sure to look the part to faraway lands where Vests and binoculars were binoculars were sure to look the week of Itll be a animals of amazing adventures. too. Itll be a full part too. amazing full week and daring animals and daring adventures June 12th, 13th & 14th Down on the Farm: Hitch up your overalls, and

June 5th, 6th & 7th - Rumble in the Jungle

June 12th, our & 14th - Down on the begin. jump right in,13thfarm lovinweek is about to Farm Well get our hands Hitch up your as we take on a few chores like planting a garden, dirty this week overalls, and jump right in, our farm lovinweek is about to begin. Well and gathering eggs. Well take a take on a few chores churning butter, get our hands dirty this week as welesson from the Little like planting a garden, own wheat to and a loaf of eggs. Well take a Red Hen and grind ourchurning butter,bake gathering bread. Your little lesson from the Little Red Hen and buckaroos wont want to miss it! grind our own wheat to bake a loaf
of bread. Your little buckaroos wont want to miss it! June 19th, 20th & 21st Welcome to Pooh Corner: Come with us on an June 19th, 20th & 21st - Welcome to Pooh Corner

imaginative journey through the journey throughWoods with Winnie the Come with us on an imaginative Hundred Acre the Hundred Acre Pooh and all of his friends. Well plant his friends. Well plant carrot Woods with Winnie the Pooh and all of carrot seeds with Rabbit, read books with Owl, do some bouncing with Tigger bouncing with Tigger seeds with Rabbit, read books with Owl, do some and Roo, and of endless with the timeless,endless with the timeless, Winnie the Pooh of Winnie and Roo, and of heart-warming tales of heart-warming tales

the Pooh. June 26th, 27th & 28th A Seussville Sensation: Join Horton, the Sneetches,

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riddle in style. week with some friends, Dr. Seuss, and yourself. July 10th, 11th, & 12th Adventures in Sherwood Forest: Oo-de-lally oo-de-lally

and old26th, 27th & 28th - A Seussvillefun than anything in town. June Mr. Brown for a week that is more Sensation Well cook up some Moose Juiceold Mr. Brown forand Ham, and eat with Join Horton, the Sneetches, and and Green Eggs a week that is more byfun than anything the Fox in his Socksup some Moosestyle. and Green for a while, and in town. Well cook will riddle in Juice week with some friends, Dr.and eat with yourself.while, and the Fox in his Socks will Eggs and Ham, Seuss, and by for a

July 10th, 11th & 12th - Adventures in Sherwood Forest golly what a day! Come along to the Sherwood Fores. Well join Robin Oo-de-lally oo-de-lally golly what a day! Little John would enjoy. Hood and Maid sure to be an adventureCome along to the Sherwood
Forest. Well join Robin Hood and Maid Marian as they dodge the sneaky Sheriff. Well look the part in our feathered caps and flowing headdresses too. Its sure to be an adventure Little John would enjoy.

payment
______# of Camp Weeks ($145)= ______ Amount Paid in Full _______________ Cash Check Card
* Early Registration Discount: If you register before May 15th ($125)
In compliance with Americans with Disabilities Act, Kids Village will make all reasonable efforts to accommodate persons with disabilities. Please indicate any special needs of participant(s) below. Please read this form carefully and be aware that in signing up and participating in the use of Kids Village programs, you will be waiving and releasing all claims for injuries you might sustain arising out of the activities of this program. Your signature is required on this form. Waiver & Release of All Claims As a participant or parent/guardian of participant(s) in these program(s)/activities, I recognize and acknowledge that there are certain risks of physical injury and I voluntarily agree to assume the full risk of any injuries, including death, damages or loss, regardless of severity, that my minor child/ ward or I may sustain as a result of participating in any and all activities connected with or associ ated with such program(s)/activities held on or off Kids Village property (including transportation services/vehicle operation, when provided).

Payment 18th & 19th - Clowning Around July 17th,

July 17th, 18th & 19th Clowning Around: Come one, come all, to the Greatest Show in Town! Join us for this ______# Camp Weeks ($145) =___________ Big Top adventure and prepare to clown around. With lemonade and cracker jacks, potato sack races, and face Cash Amount Paid in Full _______________ painting, this week is your Check Card chance to experience some good old fashioned Big Top Fun. So brush up your juggling Discount: your register before May join us for ***Early Registrationact, dust offIf you giant red shoes, and15th ($125)some serious circus fun!

I further agree to waive and relinquish any and all claims I or my child/ward may have as a result of participating in these program(s)/activities (held on or off Kids Village property) against Kids Village, including its independent contractors, ofcials, agents, volunteers, servants, and employees. I do hereby fully release and forever discharge Kids Village and its independent contractors, of cials, agents, volunteers, servants, and employees from any and all claims from injuries, including death, damages, or losses sustained by me or my minor child/ward and arising out of, connected with, or in any way associated with these program(s)/activities (held on or off Kids Village property) or the transportation services. I have read and fully understand the above Waiver & Release of All Claims. Signature of Adult/Parent/Guardian 18 years of age or older:
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