KIDS’ KLUBS INC.
DAY CAMP REGISTRATION FORM

DATES:July 26 30, 2010

CHILD’S NAME _________________________________________ ENTERING GRADE _____ (in Sept.)

DATE OF BIRTH ____/____/____ AGE __________ Sex _______ Home Phone __________________

WORKPHONE (F) _________________________ (M) _______________________

PARENT NAME(S)_____________________________________________________________________

MAILING ADDRESS____________________________________CITY/ST ______________ZIP_______

RETURN THIS FORM TO: KIDS’ KLUBS INC. with $20 registration fee
Box 163 ($10 is Non-refundable)
Malden IL 61337
815-643-2307

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