Child's Name*

Child's Classroom*

Child's age*

Parent's name*

Parent's email*

Address

Phone

School / Organization
—Please choose an option—Albrook School, Basking RidgeThe Academy for Children of Mountain LakesBridges to Learning, RockawayBright Horizons, anyChatham Day School, ChathamChildtime, Pine BrookCreme de la Creme, BridgewaterEast Rutherford MontessoriFarbrook School, Short HillsFriendship Center, HackettstownGan Aviv, BergenfieldGoddard School, Englewood CliffsGoddard School, WayneGoddard School, ParsippanyGoddard School, Elmwood ParkHanover Recreation, Hanover TownshipHudson Montessori, Jersey CityJina Child, CliftonKiddie Academy, SecaucusKiddie Academy, SpartaKiddie Academy, SpringfieldKiddie Academy, HobokenKidoodle, ButlerKindercare, WhippanyLightBridge Academy, MillburnLightBridge Academy, WestfieldLightBridge Academy, WhippanyLight Bridge Academy, BergenfieldLight Bridge Academy, CLiftonLittle Learner Academy, DenvilleLittle Stars, CliftonLearning Tree Academy,Wood RidgeMonmouth Junction, South BrunswickMontclair Kimberly Academy, MontclairMontessori Learning House, MonroeMy Special Spot, Cedar KnollsNursery School at Christ Church, Glen RidgeOur Little Schoolhouse, SomersetPrimrose, Berkeley HeightsPrimrose School, MountainsidePrimrose School, Other LocationStepping Stones Montessori, NetcongSunnyfields Learning Center, WhippanyTutortime, West OrangeYoung World Day School, Mahwah
Kids in Motion Class
—Please choose an option—Bounce TennisCircus with a PurposeHip HopIncredible AthletesRelay RiptideSoccer SmilersYoga TumblersZumbaOther

Your child will remain under the care, direction and supervision of the school while receiving instruction in the Kids in Motion programs. I hereby release and discharge, Kids in Motion, the childcare facility, and its members from all actions, claims, demands, injury or damage resulting from my child’s participation in this activity. There are NO refunds for missed classes.
I agree with the Liability Release
I give Kids in Motion permission to publish pictures and/or videos of my child participating in the Kids in Motion programs.
I agree with the Photo ReleaseI don't want my child photographed