ART'ifice Ltd

Royal RD, Floreal

Tel: 00 230 686 66 66

Phone: +230 5933 8666

Email: [email protected]

Website: www.nauliniaubeeluck.com

BRN: C1005 1327

APPLICATION FORM

KIDDY FUN CLUB

First Name *

Last Name *

Gender *

Male

Female

Date Of Birth *

Responsible Party Contact Details

(Home)

(Cell) *

(work)

Emergency Phone Number *

Address *

Email *

Medical Condition (if any) *

> Organizer does not take responsibility to offer meals to participant.

> Organizer will not be held responsible for any lost objects or valuable of participant.

> Organizer will not be held responsible for any accident,incident or illness occured during the kiddy fun club,inside our premises or during outings.

> Participant does not have any objection of his/her photo or image being used by the organizer in any promotional tools(Website / Social Media / Newspaper / Television, etc).

> Participant should be fit and in good health.

> Whole amount of payment should be effected in advance and is in any case non-refundable and non-transferable.

I Responsible Party *

of above-mentioned Participant declare that all information given are right.I also agree upon the above terms and conditions. I am aware of the full program and activities of the kiddy Fun Club.

Please Write "Read and Approved" *

Your KID'S Photo *

Your KID'S Photo

Signature: *

Clear

(Responsible Party)

Please direct payments to the following:

Art'ifice Ltd - BRN : C10051327

MCB JuicePro Account - 000451194748

ABSA Account - 121037556

Grateful if you could plz send the receipt by either JuicePro or ABSA on 59 33 8666, with your name included.

Thanking you for your kind support and cooperation.

OFFICE USE:

PAYMENT:

REFERENCE NO: KFC............/2024

REMARKS: