Mt.Kisco Recreation
I
Participants will decorate one dozen fresl1baked cookies and take them home after the
class to share with the entire family. We will provide all of the materials needed. You
just provide the creativity:) Class size is limited so register early!!
Location:
Memorial Pool Complex, Leonard Park
Grades:
K ~ 6th
Time:
4:15pm - 5:15pm
Fee:
$12 per child
Date:
Wednesday, December 19,2012
Supervisor:
Allison Eckhart
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Name
Age _ _ _ __ ------------------------------ Grade - - - - -
Address
-------------------------
ParentiGuardian's Day Phone: _____________
Home Phone ------Email ---------------
Does your child have any medical/dietary concerns? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ General Release: The undersigned hereby releases the ViliagefTown of Mount Kisco, it's Village Board
and Commission Employees and volunteers thereof any responsibilities should an accident or injury
occur to the above named participant as a result of participation in the aforementioned program
sponsored by the Mt. Kisco Recreation Commission. I understand the Recreation Commission may use
photos taken during the events/activities unless I notify them in writing.
P.arentiGuardian Sig nature ____________________
Office Use Only: Receipt # _ _ __
Date - - - - - , - - - ­
RecTrack # _____ Date _ _ __