Kids in the Kitchen

Childs Name*

First NameLast Name
Parents Name*

Mom's First NameMom's Last Name
Email*
Cell*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
We like to tag parents in pictures on our social media! What is your Instagram handle(s)? (optional)

Other information
Does your child have any food or environmental allergies?*

YesNo
Please list their allergies
Emergency Contact

Emergency contact must be someone other than the parents
Please list any additional people that may pick up or drop off your kids (someone other than Mom or Dad who may drop off or pick up your child)

Parental Consent for Emergency Treatment

I hereby consent to allow the administrators of Aish to take whatever medical measures necessary at my expense, for my child, in the event of a medical emergency.
Signature*

Clear
Click and Drag your mouse to form your signature
Date:*

MonthDayYear
Date
Liability WaiverRelease and Indemnification
I, the undersigned parent of*
hereby consent to my child's participation in Aish activities. I hereby release, waive, discharge and indemnify Aish, their affiliates, agents, officers, directors, supervisors, and employees (herein referred to collectively as "Aish") from and against any and all claims for property damages, liability or personal injuries which my child may sustain. I further agree to indemnify and defend against any and all claims for property damages, liabilities, or personal injuries which a third party may sustain by reason of any act or omission of my child.

Additionally, I understand that my child or children's pictures taken while participating in any camp activities may be used by Aish for their marketing purposes.
Signature*

Clear
Date:*

MonthDayYear
Date

Kids in the Kitchen Fee$80.00

Quantity

Enter coupon

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Other information