Cost is $88 per child for the 8-week fall session (members: $56), prorated. Please note that work-study grants and partial fee waivers are available; contact the Program Coordinator for an application form.
— Fall Session 2008 Sundays: September 7 & 21, October 5 & 19, November 2, 16 & 30, December 14 —
Child's Name: ____________________________________________
Child's Birthdate: _____________________ Year in School: _____
Child's Name: ____________________________________________
Child's Birthdate: _____________________ Year in School: _____
Street Address: _________________________________________________________
City: ______________________________ State: __________ Zip: __________
Phone: (________)________________________ E-mail: _________________________________________
Parent/Guardian's Name: ___________________________ Relationship to Child/Children: ______________
Parent/Guardian's Phone Number (Please include area code)
Day: (________)__________________________ Eve: (________)__________________________
Child/Children live with: __________________________________________________________________
Please indicate any special medical needs, food allergies or emotional needs of your child/children that we should know about (specify each child):
_______________________________________________________________________________________
_______________________________________________________________________________________
I give permission for the children listed above to participate in the Clouds in Water Children's Program for the dates listed. I understand that one parent must be in the zendo on Sundays during Children's Practice. I also understand that from time to time, Clouds in Water has a photographer take pictures of children's program activities to be used in Clouds in Water promotional materials. I give permission for Clouds in Water to use any photos taken of my child. (If you do not wish to give Clouds in Water permission to use photographs of your child in promotional materials, please check here _____ ). I also give permission for my child/children to go on walks in the neighborhood, accompanied and supervised by their teacher and other volunteers.
_______________________________________ ____________________ Parent/Guardian Signature Date
Print out this registration form and send with payment to:
Clouds in Water Zen Center
308 Prince St., Suite 120, St. Paul, MN 55101
(651) 222-6968 -