Participant Last name________________First name_______________

Grade_____  Kindergarten: Session I____ Session II______________

Age________

 Parent Last name_______________________               Parents First Name__________________

E-mail_____________________________________________________

Mailing Address:____________________________________________

City/State/Zip:_______________________________________________

Home Phone:______________________Cell:__________________________

Registration Fee:  $200.00  ($100.00 one time registration fee, (non-refundable)$100.00 credited against first months tuition)

Mail registration Form and fee to :  Pam Marquardt

                                                                                         26413 SE 31st ST

                                                                                          Sammamish, WA 98075

                                                                  Make Checks payable to:  Highlands Kids Club

You will receive an email confirmation and your child's spot will be reserved once registration is received.