C L A S S   R E G I S T R A T I O N   F O R M
(Our Newsletter has the latest list of classes)
Prairie Kitchens Registration Form: Complete form and submit. Mail your check to: PRAIRIE KITCHENS LTD., P.O. BOX 372, MORTON GROVE, IL  60053. We will confirm Friday before class. Call within 24 hours of class to cancel and we'll send you a rain check. Refunds only if we cancel the class.

Name

Phone
Address
CityStateZip
ClassesPrice
GiftsPrice
Please Note: Sales Tax to be added to giftware orders is 8.25%
Total
Payment by check: Payable to Prairie Kitchens Ltd.

or Choose One  #Exp. Date. (mm/yy)  


Waiver, Release Of All Claims And Hold Harmless Agreement For Prairie Kitchens Ltd.
In registering for Prairie Kitchens programs, classes or events (the “Programs”), you agree as follows: I agree to assume the full risk, to waive and relinquish all claims, to indemnify, hold harmless and defend from all claims and do hereby fully release and discharge Prairie Kitchens Ltd., Carolynn Friedman, independent contractors or other entities or individuals and the officers, agents, servants and employees of these aforenamed that might be directly or indirectly liable, for any injuries, illnesses, damages or loss which I or anyone else may sustain as a result of my participation in the Programs. “Participation” and “programs” include all physical movements of any nature while participating in these programs and further include the provision of or failure to provide proper instructions or supervision, the use, adjustment or maintenance of any and all machinery, equipment, and anything related to the use of the services, facilities, or premises involved in these programs. “I,” “me,” and “my,” refer to parents or guardians as well as participants in the Programs. Any subsequent advisements or warnings that I receive will be incorporated by reference into and become part of this agreement.
I have read and understand this agreement and am 18 years or older.

  

Please print this page and fax to (847) 998-0740 with Signature of Parent or Guardian if you are under 18 years old.
Parent or Guardian Signature _________________________________