Please list a contact in case of emergency other than yourself.
Father or Male Guardian
Mother or Female
The Kidz Cooking Studio
Mini Summer Camp 2016 Registration Form
(Form is not mobile friendly. Please complete on a computer.)
A deposit of $50 must be made in order to hold your space for your scheduled classes. The remaining balance must be paid in full on the first day of each camp week.
Please be aware of the following:
Safety & Insurance
The safety of your child is very important to us. The Little Language Corp. strives to conduct its programs safely & expects all participants to follow safety rules & instructions which have been designed to protect and enhance the participants’ safety. The Little Language Corp. carries general liability insurance for its operations; however, please be advised that The Little Language Corp. does not carry medical insurance for accidental injuries sustained in its programs. Therefore, each person registering himself/herself or a family member for a Little Language Corp. program should review his/her own health insurance policy for coverage.
Release from Liability
I recognize and accept that there is a risk inherent in participation in group and/or physical activity, including the classes offered by Little Language Corp. I agree to assume the full risk of any physical injuries, damage, or loss regardless of the severity, which I or my child may sustain as a result of participating in any and all activities connected with or associated with any Little Language Corp. program. I, on behalf of myself, my spouse, my child(ren), and any caregiver or other person attending with my child, hereby and forever waive, relinquish, fully release and discharge Alberta Gulotta, The Little Language Corp., its directors, instructors & staff, and the landlords, agents, & employees of the facilities in which classes are held, from any and all liability or claims resulting from bodily/personal injury, property damage, medical expenses or other loss sustained in connection with such classes.
Permission to Secure Treatment
In the event of an emergency, I authorize The Little Language Corp. to secure from any licensed hospital, physician, or medical personnel any treatment deemed necessary for my child’s immediate care & I assume responsibility for payment of all medical services rendered.
All participants agree that any photography or video taken while participating in class or special events may be used for promotional purposes for Little Language Corp.