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Child #1

* Name Of Child:
*Birth Date:
(MM-DD-YYYY)
*Medical conditions/allergies:
*School Name and Grade:

Add Another Child

Child #2 (Remove)

Name Of Child:
Birth Date:
(MM-DD-YYYY)
Medical conditions/allergies::
School Name and Grade:

Parent/Guardian Information

*Parent/Guardian Name:
*Address:
*Email Address:
*Home phone number:   -     -  
*Mobile phone number:   -     -  
*Emergency contact person:
*Emergency contact phone number:   -     -  

Child #1

* Program #1:
*Preferred Location(UES or UWS), Day and Time:
* (Please refer to our schedules and enter your preferred location, date and time above.)
Program #2:(Optional)
Preferred Location(UES or UWS), Day and Time:
* (Please refer to our schedules and enter your preferred location, date and time above.)

Add Another Child's Program

Child #2 (Remove)

Program #1:
Preferred Location(UES or UWS), Day and Time:
* (Please refer to our schedules and enter your preferred location, date and time above.)
Program #2: (Optional)
Preferred Location(UES or UWS), Day and Time:
* (Please refer to our schedules and enter your preferred location, date and time above.)

By his/her signature above, participants hereby acknowledge and consent that images of their child(ren) may be used for business promotion. The individual permits FasTracKids to take whatever steps to obtain emergency medical care, if warranted. The individual hereby releases and discharges FasTracKids from any and all claims and demand of any kind for injury which the child may suffer or sustain directly or indirectly as a result of participation in FasTracKids' programs. Cancellations & Refund Policy: We make staffing arrangements and other provisions upon enrollment of your child. Therefore, we regret that we cannot offer refunds in the event of your child's withdrawal from our classes. However, we do understand that sometimes a withdrawal is unavoidable. In that case, the unused portion of the tuition will remain on file as a credit to be used within one year from the date of the withdrawal for any of our programs and camps and can also be used for a sibling.

I agree to the above conditions and disclaimers.

Preschool, summer camp, and tutoring center in NYC