Rainbeau Ridge

Summer Buds Registration 2008

You are registering your child for the Buds Summer 2008 Program. Buds classes meet on Thursdays, from 9:30-11:30am, from July 3rd through August 21st. The fee is $350 for the 8-week program.

When you complete this form, there are two more steps to completing this registration. You will be asked to print, sign and return a consent form and you will also be directed to a secure site that will allow you to make your credit card payment for the program. You will receive a confirmation of your completed registration by e-mail or phone from Rainbeau Ridge.

Please contact us at 914-234-2197 if you have any questions about the registration process.

Bud's First Name *

Bud's Last Name *

Birthdate *

Grade as of September 2008

Gender *	M F

Home Address *

City *

State *

Zip *

Home Phone *

Work Phone

Email *

Mother's Name

Mother's Cell #

Father's Name

Father's Cell #

Caregiver's Name

Caregiver's Cell #

Physician's Name *

Physician's Number *

Emergency Contact Name *

Emergency Contact # *

Allergies? *	Yes No	Does your child have any allergies?

Allergy Details		Please let us know of your child's allergies.

Special Needs? *	Yes No	Does your child have any special needs or limitations? If yes, please explain below.

Special Needs/Limitations		Please provide details of any special needs or limitations.