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Alphie is excited to be coming to Doby's Bridge Elementary!
DBES Reading Giraffe 2017 Winter Session
TUESDAYS from 2:30pm - 3:30pm in the LIBRARY
January 24th - March 14th, 2017
8 Classes for $90

Student Name *

First

Last

Grade *

K 1st 2nd 3rd

Teacher's Last Name *

Is your child in FLYERS? *

Yes No

How does your child get home? *

Car Rider Bus Rider

If a Bus Rider, please specify the bus name. *

Primary Contact Name *

First

Last

Primary Contact Phone *

Primary Contact Email *

Secondary Contact Name *

First

Last

Secondary Contact Phone *

Secondary Contact Email *

Please list any allergies, medical concerns, or anything else you'd like us to be aware of. *

Do we have your permission to take photos/videos of your child? These will only be used on the company or school websites, or the company Facebook page, and will be without compensation. Your child’s name and identity will NOT be revealed. *

Yes No

Program Waiver
As a parent/guardian of a program participant, I acknowledge there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages or loss which I or my minor child/ward may sustain associated with the program. I agree to waive and relinquish all claims I or my minor child/ward may have as a result of participating in the program, against Playball, Reading Giraffe, and the city or school that hosts the camp and all of their officers, agents, servants and employees.

In the event of an emergency, I authorize officials of the program to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my minor child’s/ward’s immediate care and agree that I will be responsible for payment of any and all medical services rendered, including transportation charges. My child/ward has no medical conditions that would prevent him/her from participating in the program.

Waiver Authorization *

I agree to the terms of the above waiver.

Pay For Session ($90) via *

Check (We will email you payment instructions.) PayPal (We will email you a PayPal inoice.)

Submit

Thank you for signing up for Reading Giraffe at Doby's Bridge Elementary!

You will receive a "Welcome" email when we process your registration. If you are paying via PayPal, you will also receive an invoice. If you are paying via check, please make it payable to Playball and mail it to: Derick Wilder, 415 Meadowside Drive, Fort Mill, SC 29715.

We look forward to seeing your child in class!

We'd love to hear from you! Email, phone us, or check us out on Facebook!

Telephone

803-487-4687

email

CoachDerick@yahoo.com/

Alphie is excited to be coming to Doby's Bridge Elementary!DBES Reading Giraffe 2017 Winter Session​TUESDAYS from 2:30pm - 3:30pm in the LIBRARY​January 24th - March 14th, 2017​8 Classes for $90

Telephone

email

Alphie is excited to be coming to Doby's Bridge Elementary!
DBES Reading Giraffe 2017 Winter Session
TUESDAYS from 2:30pm - 3:30pm in the LIBRARY
January 24th - March 14th, 2017
8 Classes for $90