Please submit the following registration from for the Action Kids Academy after school program. 1 Step 1 After School Program Registration Form Child's First name Child's Last name DOBdate_range Child's School Child's Grade Parents Name Cell number Address Town Zip Emailbest email for us to reach youemail Health issuesPlease ouline any health issues you feel will impact your child at our program. Please include any allergies.0 / My child will require the following during the after school porgramEpi-penInhalerPrescription medicationNone Academic InformationPlease briefly describe any academic challenges that may be helpful for us to be aware of at homework time.0 / Sign Me Up forTerm One; September 7 to December 23Term Two; January 3 to April 22Term Three; May 2 to Last day of SchoolI am looking to add a few days here and there Sign me up for the following daysAfter school to 6 pmSign me up for the whole week! Monday TuesdayWednesday Thursday Friday I am interested in attending on an occasional basisCheck here (please list requested dates below) Enrollment notes0 / After School Administrative Policies Make ups for missed after-school days are not available. You will not be charged tuition for days that we do not operate the program. Tuition will be charged to the card on file on Fridays for the upcoming week. We do not run the after school program on days that there is no school. Sign up for Vacation Camp or our Schools Out – We’re In! programs instead. Pick up is 6:00 pm. An additional charge may apply for pick ups after 6:00pm. Please email [email protected] if you will be late picking up your child. If your child will be absent from the After School program for any reason, please email us at [email protected] ConfirmationI have read and acknowledge the above administrative policies. Waiver/Release I, the duly authorized parent or guardian of the above-named Minor “Participant”, understand that the individual and/or group gymnastics and other physical exercise sessions, programs or activities conducted at Action Kids at Brentwood Commons, Inc. (hereafter “Action Kids”) may involve gymnastics, tumbling, fitness, trampoline, cheerleading, dance, ball sports, swimming and martial arts, as well as the use of exercise equipment, amenities and facilities owned and/or operated by Action Kids, its representatives or its contractors (collectively, the “Activities”). I, as the parent/guardian of the below-named Minor Participant, as a condition of authorizing their participation in such Activities do hereby agree to RELEASE and DEFEND, HOLD HARMLESS, and INDEMNIFY Action Kids, its shareholders, directors, officers, agents, faculty, volunteers, employees, representatives and contractors (hereinafter “the Releasees”) from all liability, claims, expenses, fees, fines, penalties, losses, suits, proceedings, actions and costs including attorneys’ fees and court costs, including personal injury and death, resulting from or arising out of their participation in the Activities whether caused by the alleged NEGLIGENCE of the Releasees or otherwise. I understand that the Activities in which my child or ward will be engaged may be dangerous, and I, as their parent or guardian, voluntarily choose to assume those dangers. I also recognize that by participating in the Activities my child or ward may experience injuries including, but not limited to, death or disability, and I willfully ASSUME THOSE RISKS. I agree that THIS LIABILITY RELEASE AGREEMENT IS BINDING ON THE PARTICIPANT AND THEIR PARENTS OR LEGAL GUARDIANS, PERSONAL REPRESENTATIVES, HEIRS, AND ASSIGNS. In the event of accident or emergency, I hereby authorize Action Kids to transport the Participant, or cause the Participant to be transported, to a medical facility for medical treatment and I agree to release, indemnify, defend and hold Action Kids and its representatives harmless with regard to same. I hereby agree to be fully and solely responsible for all medical expenses which may be incurred as a result of the Participant’s participation in the Activities. I understand that my child or ward’s participation in the Activities at Action Kids may be photographed, video recorded, audio recorded, or otherwise recorded. I acknowledge that Action Kids retains the right to use such photographs, video or audio recordings or any other recording of events for publicity, advertisement or any other legitimate purpose and I hereby consent to such use. ConfirmationI, as the parent or guardian of the above-named Minor Participant, certify that I have carefully read the foregoing Liability Release Agreement and by my signature below, including any signature affixed in electronic format, consent to be bound by its terms. If I am not the parent or guardian of the below-named Minor Participant, by my signature below, I nevertheless agree to all of the terms and obligations in this Liability Release Agreement, as though I was the parent or guardian of the Minor Participant. Electronic SignatureParent/Legal Guardian Full Name Datedate_range Submit Form keyboard_arrow_leftPrevious Nextkeyboard_arrow_right FormCraft - WordPress form builder
