The Happy Bookworm, Inc.
phone: (516) 521-5463
info@thehappybookworm.com
Online Registration Form
Child Last Name:
Child First Name:
Child Birth Date:
Class:
Address:
City:
Zip Code:
Home Phone:
Cell Phone:
Mother's Name:
Father's Name:
Email Address:
Allergies:
No
Yes
If Yes, please specify:
I give permission for my child's photo to appear in the
pamphlet or on the website for The Happy Bookworm, Inc.
I DO NOT give permission for my child's photo to appear in
the pamphlet or on the website for The Happy Bookworm,
Inc.
I have read and agreed with the policies stated on this page.
We will contact you by email or phone to let you know that we have
received your registration and payment.
registered on a first come
first served basis.

2.  If for some reason you
need to cancel the session,
the following fees will apply.  
There will be a $25
cancellation fee for canceling
prior to the first class.  There
will be a $50 cancellation fee
for canceling prior to the
second class.  There will be
no refund after the second
class.

3.  The Happy Bookworm,
Inc. has the right to cancel
any class based on limited
enrollment.  If a class is
canceled, all tuition and fees
will be refunded.

4.  The accompanying adult
is solely responsible for the
safety of his or her child or
child committed to his or her
care while at The Happy
Bookworm, Inc.  The Happy
Bookworm, Inc. and its
employees will be held
harmless for any accident or
injury to all adults and
children participating in
activities in The Happy
Bookworm, Inc.