To register: Mail or drop off. If paying by check, please make the check payable to: The Incline Club, Inc. Tuition must be received one week prior to selected weeks. Walk ins must be paid upon arrival. Aftercare $5.00 an hour must be paid when child is picked up. If you schedule your child please make sure you keep the schedule day. We will only carry over days during that week. They will not be carried over to the next week. You will not be refunded for days missed. Refunds will only be available with a doctor's written note.

Name: ______________________________________________________

Address _____________________________________________________

Phone: ________________Date of Birth _____________Age _____Sex __

Emergency Contract/Phone: _____________________________________

Mothers Name/Work Place/Phone _________________________________

Fathers Name/Work Place/Phone __________________________________

Current health status ____________________________________________

Is child on any medication _______________________________________

Restrictions ___________________________________________________

Medical Doctor/Phone __________________________________________

Medical Insurance/Insurance No. __________________________________