Registration

Contest Rules

Please use the following form to register. Once you have submitted the application, you will be contacted by a Kid Space representative.

Child's Name
Child's Age
T-Shirt Size	S/M/L/XL
Parent/ Guardian Contact Information
Parents Name(s)
Address
Address /Apt. #
City
State/Province
Zip/Postal Code
Home Phone
Work Phone
Cell Phone
Email
Secondary Emergency Contact Information
Name(s)
Address
Address /Apt. #
City
State/Province
Zip/Postal Code
Home Phone
Cell Phone
Relationship
Additional Emergency Contact Information
Name(s)
Address
Address /Apt. #
City
State/Province
Zip/Postal Code
Home Phone
Cell Phone
Relationship
Allergies / Medical Conditions
Please list any and all allergies or medical conditions

Release for Pick Up
Please name upto 3 people in addition to you or your spouse who may sign out your child from our center without prior written permission. These individuals will be allowed to remove your child from our care without contact from you, after showing a valid driver’s license.
Name & Relationship
Name & Relationship
Name & Relationship
Please notify the Director in writing of any persons who are to have no contact with your child. Please include a copy of any No Contact Order per any court decision. This includes custody disputes. By clicking "Submit Form" below, you state that you have read and agree to the rules and conditions outlined in the: Kid Space Summer Camp Policies and Procedures.

462 SW Port Saint Lucie Blvd., Port St. Lucie, FL 34953
Tel: (772) 340-2140 Email: info@KidSpacePartyPlace.com

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