cdaspringkids

We'll handle the kid stuff.	Children's Program Registration Form - California Dental Association - May 14-17, 2009

There are two ways you can register for the children's program:
1. Complete and submit the online form listed below.
2. Download the Adobe Acrobat version of this form to mail or fax to us, click here:
Acrobat Version of Registration Form.
It is not necessary to do both.

Where, When, For Whom

There will be a "Children's Program" for children ages 6 months through 6 years old and a "Youth Program" for ages 7 through 12 years old located at the Hilton Anaheim in Anaheim, California. Snacks and beverages will be provided. Meals can be supplied by parents or purchased when checking your child in each day. Parents with infants must provide diapers, changing supplies, milk, formula, baby food, etc. Please label personal belongings and lunches. Medication will NOT be administered by KiddieCorp. Be sure to fill out the following form COMPLETELY. To ensure a safe and fun-filled environment, any child who is ill will not be admitted to the children's program.

The cost for the "Children's Program" is $40 per child for a full day or $20 per child for a half day. The cost for the "Youth Program" is $30 per child for a full day or $15 per child for a half day.

Kid's Zone Program
A "Kid Zone" will be provided for ages 4-12 years old on the exhibit floor during exhibit hours. The cost for the "Kid Zone" is $5 per child with a daily three-hour maximum per child. The "Kid Zone" program is first-come, first-served and you cannot pre-register for this program.

The advance registration deadline is April 16, 2009. Register early as availability is limited and handled on a first-come, first-served basis. This form must be completed in its entirety and payment received before registration is confirmed.

Cancellation Policy
Cancellations must be made to KiddieCorp prior to April 16, 2009 for a full refund. Cancellations made after April 16, 2009 will not be eligible for a refund.

No-show Policy
Parents who do not arrive within 15 minutes of their reserved times will forfeit their reservations and not be eligible for a refund.

Stroller Check
For the convenience and safety of all attendees, strollers are not permitted on the exhibit floor. A stroller check will be available for $2 per item.

Parent Information:

Parent Name(s):

Home Phone:

Work Phone:

E-mail Address:

Full Mailing Address:

Check here if your child(ren) has/have any special needs under the Americans with Disabilities Act. We will contact you so that we may make appropriate arrangements to accommodate your child. Please provide details in the box below.

Check here if any of your children have health limitations or special needs. Please let us know so that we may ensure your child(ren)'s needs are met. Please provide details in the box below.

Child(ren)'s Names and Ages:

1. Name: Age:

2. Name: Age:

3. Name: Age:

4. Name: Age:

5. Name: Age:

Dates & Times:

Thursday, May 14 -- 8:00am to 6:30pm

Drop-off Time: am pm Pick-up Time: am pm

Friday, May 15 -- 7:00am to 6:00pm

Drop-off Time: am pm Pick-up Time: am pm

Saturday, May 16 -- 7:00am to 6:00pm

Drop-off Time: am pm Pick-up Time: am pm

Sunday, May 17 -- 8:00am to 2:30pm

Drop-off Time: am pm Pick-up Time: am pm

Payment in full is required to confirm your reservations. Although every effort will be made to accommodate late or on-site registrations, there is no guarantee that KiddieCorp can accept children unless they are pre-registered. Please make sure to bring a photo I.D. with you to the children's program. A photo I.D. will be required for check-in and check-out of children. We will have you complete a consent form when you arrive at the children's program.

Calculating Fees & Payment Options:

Children's Program (ages 6 months - 6 years old):
Full Day: $40 per child X # of Children X # of Days =
Half Day: $20 per child X # of Children X # of Days =

Youth Program (ages 7 - 12 years old):
Full Day: $30 per child X # of Children X # of Days =
Half Day: $15 per child X # of Children X # of Days =

TOTAL FEE:

KiddieCorp accepts checks and money orders (in U.S. dollars only), MasterCard, Visa and American Express.

If you are paying by credit card, please enter your card number and print a copy of this completed registration form for your records BEFORE you submit on-line. Confirmations will not be sent. If you prefer, you may fax the form to (858) 455-5841.

Credit Card Number: Expiration Date:

Check here if you are paying by check.

If you are paying by check, please print two copies of this completed registration form. Confirmations will not be sent. Keep one copy for your records and mail the other copy along with your check or money order to:

KiddieCorp/CDA
8961 Complex Drive
San Diego, CA 92123
(858) 455-1718