Class Registration Form

To register on-line, simply fill out the form below and submit it to CommuniKids.

Your place in the class is not guaranteed until we receive your payment.

Once you submit your form, you may submit your payment via the “PayPal” link on the confirmation page. You may also mail your payment to us at:

CommuniKids
3920 Alton Pl., NW
Washington, DC 20016.

If you have any questions, please call us at 202-363-0133.

Thank you!

*Child's First Name:

*Child's Last Name:

*Date Of Birth:

*Gender:

*Parent's Name:

*Address:

*City, State, Zip:

*Home Phone:

Work/Cell Phone:

*E-Mail Address:

Please list any

food allergies that your

child may have:

*Choice of Language:

*First Class Choice:

Day of the Week and Time

*Second Class Choice:

Day of the Week and Time

*Age Group:

* Please choose a location:

I release CommuniKids and the Wisconsin Avenue Baptist Church from any and all liability, loss, damage, costs, claims and/or causes of action, including but not limited to all bodily injuries arising out of participation in CommuniKids classes. I further agree to indemnify CommuniKids and the Wisconsin Avenue Baptist Church, their employees, members, agents, representatives and other organizations affiliated with them and hold them harmless for any liability, loss, damage, cost, claim, judgment or settlement which may be brought or entered against them as a result of participation in this course.

All participants agree that any photography or video taken while participating in a class or special event may be used for promotional purposes for CommuniKids.

I agree with this waiver*