KIIDS  SOCCER CAMP

APPLICATION

Complete and return this form along with a check payable to KIIDS Inc. to: 

1820 MAPLE HILL ST

Yorktown Heights, NY 10598

C/O BERARDI 

CHILD  Name:________________AGE________

PARENTName:______________ /_____________ Last_______________

Street:______________________________City:__________________Zip:_____

Home Phone: (_______)________________CELL PHONE________________ 

Emergency Contact Name: ____________________________  PHONE NUMBER___________________________

E-Mail Address: __________________@_______