Kids Adventures / Teen Adventures

Kids Adventures at KALACHAKRA 2011 Registration Form

For ages 4-12

Please fill out the following form to register for KALACHAKRA 2011.
NOTE: A separate Registration is required to be submitted for each child participating.

Child Information
Is this child a sibling of another participant?
If yes, name of sibling:

Name of Child:
Birth Date:		NOTE: Children must be between 4 and 12 years of age.
Male or Female

Home Address:
Home Address:
Home Address:
Home Phone:

Parent/Guardian # 1:
Daytime Phone:
Mobile Phone:
E-mail Address:

Parent/Guardian # 2:
Daytime Phone:
Mobile Phone:
E-mail Address:

Local Contact Information
Local Address (i.e. hotel, home, etc.)
Home/Home Name:
Street Address:
Street Address:
City:		State: Zip:
Local/Hotel Phone:
Room # (if known):
Name on Reservation:
Mobile Phone: (on hand during visit)
Persons Authorized to pick up children

Requested Dates of Care
Please select the desired dates of care. Prices for each day are indicated next to each day of care. Payments should be made at the time of drop off. Checks are preferred but sash is also accepted. Checks should be made payable to CATA (CAPITAL AREA TIBETAN ASSOCIATION INC). NOTE: Please note that KALACHAKRA 2011 will be subsidizing 50% of the child care costs for the first 30 registrants.
Wednesday, July 6, 2011 6:30am - 5:00pm ($26 for first 30 registrants, $52 for all registrants after first 30)
Thursday, July 7, 2011 6:30am - 8:30pm ($31 for first 30 registrants, $62 for all registrants after first 30) (Closed 12:00 noon - 1:00pm and 5:00pm - 6:00pm)
Friday, July 8, 2011 6:30am - 3:00pm ($21 for first 30 registrants, $42 for all registrants after first 30)
Saturday, July 9, 2011 6:30am - 8:30pm ($31 for first 30 registrants, $62 for all registrants after first 30) (Closed 4:30pm - 6:00pm)
Sunday, July 10, 2011 7:30am - 4:30pm ($14 for first 30 registrants, $28 for all registrants after first 30) (Closed 11:00am - 12:30pm)
Monday, July 11, 2011 7:30am - 8:30pm ($25 for first 30 registrants, $50 for all registrants after first 30) (Closed 11:00am - 12:30pm and 4:30pm - 6:00pm)
Tuesday, July 12, 2011 6:30am - 8:30pm ($27 for first 30 registrants, $55 for all registrants after first 30) (Closed 12:00 noon - 12:30pm and 3:30pm - 6:00pm)
Wednesday, July 13, 2011 6:30am - 8:30pm ($32 for first 30 registrants, $64 for all registrants after first 30) (Closed 5:00pm - 6:00pm)
Thursday, July 14, 2011 6:30am - 8:30pm ($34 for first 30 registrants, $68 for all registrants after first 30) (Closed 5:30pm - 6:00pm)
Friday, July 15, 2011 6:30am - 8:30pm ($34 for first 30 registrants, $68 for all registrants after first 30) (Closed 5:30pm - 6:00pm)
Saturday, July 16, 2011 6:30am - 5:30pm ($28 for first 30 registrants, $56 for all registrants after first 30)

Additional Comments
Please provide any additional information or concerns regarding your service request: