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(508) 359-7800
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PARENT or GUARDIAN
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EMERGENCY CONTACT (if parent cannot be reached)
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PAYMENT
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DAILY SESSION
$55/$63 Members/Non-Members Daily Rates




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ALLERGIES (List ALL known - include reaction and management of reaction)
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MEDICATIONS (List ALL medications taken routinely)
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PARENT AUTHORIZATIONS

The undersigned accepts fully that the Kingsbury Club, its shareholders, directors, officers, employees, representatives, and agents cannot be held responsible for any loss, claim, injury, damage, or liability sustained or incurred during participation on the premises of the Kingsbury Club.

The Kingsbury Club reserves the right to photograph program participants for publicity purposes, in print or electronic media.
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© 2020 Kingsbury Club | 2 Ice House Road | Medfield MA 02052 | Phone: (508) 359-7800
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