After emailing us at firstname.lastname@example.org to let us know which class you plan on registering for you will have 5 business days for payment to be received. if payment is not received, we will need to release the spot.
Please print this form and mail it along with a check (made out to The Happy Bookworm, Inc.):
The Happy Bookworm, Inc.
P.O. Box 376
Syosset, NY 11791
Class Location: ___________________________________________
Class Day: _____________________________
Class Time: ____________________________
Class Price: ____________________________
Child's Last Name _________________________________________
Child's First Name _________________________________________
Child's Birthdate __________________________________________
Home Phone Number________________________________________
Emergency Contact Number __________________________________
Cell Phone Number__________________________________________
Mother's Name ____________________________________________
Father's Name _____________________________________________
Email Address _____________________________________________
Does your child have any allergies?
If you are signing up with a friend, please write his/her name here:
Please choose one of the following and sign:
_____ I give permission for my child's photo to appear in the pamphlet or on the website for The Happy
_____ I DO NOT give permission for my child's photo to appear in the pamphlet or on the website for The
Happy Bookworm, Inc.
Signature & Date
We will contact you by email or phone to let you know that we have received your registration and
Copyright © 2018
The Happy Bookworm - All Rights Reserved