KALEIDOSCOPEKIDS.COM
2008 REGISTRATION FORM
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It is recommended to use when filling out this form online
Please make checks payable to KALEIDOSCOPE and mail directly to:
KALEIDOSCOPE  BOX 506  ANDOVER, MA 01810
This form may be filled out online, printed & Faxed 
To 978-475-1422  If form is faxed or Emailed please mail check within 24 hours.

If check is not mailed within 24 hours, registration cannot be confirmed.
Form can be used to register two children. If you wish to register more than two,
you may attach information to this form.

  • 1st CHILD CURRENT GRADEAGE AS OF 6/1/2008 YRS.MOS.

  • 2nd CHILD  CURRENT GRADEAGE AS OF 6/1/2008 YRS. MOS.

  • PARENTS' NAMES ADDRESS

  • CITY STATE  ZIP PHONE #

  • Email Address EMERGENCY PHONE #

Please use Schedule when listing codes. 

FIRST CHILD'S COURSES(S)
Code Course Name

SECOND CHILD'S COURSES(S)
   

QUANTITY

DESCRIPTION

AMOUNT
. ONE-WEEK COURSE (S) AT $145 =.
. MATERIALS FEES AT $10 or $15 .=
. REGISTRATION FEE AT $30 PER FAMILY

=

. EXTENDED DAY AT $75 PER WEEK .=
. FULL TIME PROGRAM AT $915 .=

ADVENTURES IN SCIENCE AT $305. =
. K.I.T.E. TUITION FEE ($295) .=
. TAX - DEDUCTIBLE  CONTRIBUTION (Applied to Scholarships) =

EARLY CARE AT $30

=

LATE CARE AT $75 =
.

TAX ID # Info Click Here                        TOTAL

=

Please check one box below indicating you payment method
Payment with credit card through PayPal (See Below)....
Check will be mailed within 48 hours (See Below).............
Note: If you have questions, please call  ( 978 )-475-1422 
Between 8:00 A.M. and 6:00 P.M. Weekdays & Weekends (Please leave a message.)
EMERGENCY CONSENT FORM

I, the undersigned parent or legal guardian of above named children will not hold Kaleidoscope, its agents, servants or employees responsible for any accidents incurred during participation in the Kaleidoscope program. If parents or doctor cannot be reached in case of emergency, consent is hereby given that the student receive medical treatment and/or surgical care as recommended by physician or hospital.
(Date) (Parent's signature)_____________________________________
Please check here > if you agree to the terms stated in the online registration form
(Child's Doctor)
(Doctor's Phone)
You may provide comments or additional Info below

You may click the submit button below to send your info  Or click print then fax or mail this form
If check is not mailed within 24 hours, registration cannot be confirmed.
Please make checks payable to KALEIDOSCOPE and mail directly to:
KALEIDOSCOPE  BOX 506  ANDOVER, MA 01810
Print a copy of this form now for your records

You may also print & fax this form to 1-978-475-1422

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If you have questions please call

978-475-1422 Between  8:00 AM & 6:00 PM  Weekdays & Weekends