Music and Movement Class

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Kiel Recreation Department

Music and Movement Class Thursday July 6th, 13th, 20th 27th, Aug. 3rd, 10th 3:30pm to 4 pm 3yrs. to 5yrs. Old 4:15pm to 4:45pm Birth to 2yrs. Old Kiel Community Center Lower Level Cost is $ 12.00 per student Name:________________________ Age:_________________ Address:_______________________ City:__________________ Home Phone:___________________ Cell Phone:____________ Email Address:__________________________________ In consideration of my child’s participation in this program, I do hereby for myself, and my heirs, personal representatives and assigns, waive and relinquish any and all claims and rights for damages I may have against any and all other participants, the City of Kiel, the Kiel Schools, and/or their assigns and representatives for any and all injuries my child may suffer or sustain while participating in this program. Date:______________ Parent/Guardian Signature:____________________________ Please return this form and payment to: checks payable to the Kiel Recreation Dept. The Kiel Community Center Attn: Missy Brandt 510 3rd Street Kiel, WI 53042 (920) 762-7090