Bead Blast Registration Form 2008
Child's Name:______________________________________________________DOB:_______/______/______ Age:________________
Address:________________________________________________City:_____________________State:______________ Zip:__________
School:_________________________________________________________________________Grade in Fall:_______________________
Parent(s) Names:___________________________________________________Home Phone:____________________________________
Parent Cell Phone:__________________________________________________Parent Work #:___________________________________
Emergency Contact Name:___________________________________________Home Phone:____________________________________
Emergency Contact Cell Phone:_______________________________________Relationship to child:______________________________
**All morning sessions for RUBIES will run 9:00 to 11:30 am Tuesday through Friday for ages 7-10.
**All afternoon sessions for SAPPHIRES will run 1:30-4:00 pm Tuesday through Friday for ages 11-15.
Please check each week attending below and circle session time:
_______Week 1: Bring on the Bling! August 5th-8th AM or PM
_______Week 2: Gotta Be (Fashionably) ME! August 12th-15th AM or PM
_______Week 3: It's MY Room! August 19th-22nd AM or PM
_______Week 4: UGH! Get Ready For School! August 26th-29th AM or PM
*A fee of $250 per week per child includes all materials and instruction.
*NO refunds are given for a missed day. Please plan carefully. If your child is sick, and space permits,
they may come for a "make up" date. Please be aware that the "make up" project will be different than the one missed due to
themes and scheduling. A materials kit will be prepared for the child to take home for assembly with a parent if a "make up" space
doesn't permit on another date.
*Please respect prompt pick up and drop off times.
*Children are encouraged to bring a water bottle labeled with their name each day.
*Bella Beads reserves the right to dismiss any child from the program for inappropriate or unsafe behavior, language, and/or
disrespect to others. No refunds will be given for days missed due to dismissal. Nor will the child be given a "make up" date.
*By signing below, I release Bella Beads, it's owners, and all it's employees /volunteers from liability of any accidents and/or injuries
while participating in the summer program. Bella Beads always puts the safety of its' participants first!
Parent/Guardian Signature:_____________________________________________Date:___________________________
Please fill out type of payment below (or send form and call with a credit card!):
Total Fee Paid:_______________________Check#:________________Cash:_______________
Credit Card: MC or VISA Expiration Date:__________________________________
Name on Card:_________________________________________________________________
Card#:______________________________________________3 Digit Code on back:_______________
Mail this form with payment to: bella beads
89 Main Street
Andover, MA 01810
*bella beads* 89 Main Street* Andover, MA 01810* 978-474-4424*
A cool place to "bead" yourself!
