Forms & Waivers

Participant Name *

First Name

Last Name

Purchaser Name *

First Name

Last Name

Phone *

(###)

###

####

Emergency Contact Name *

MUST BE DIFFERENT THAN PURCHASER/STUDENT

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Photo Release *

Yes, I give permission for my child's photo to be taken for use in print, web, and media.

No, please do not use my child's photo.

Name of Adult(s) Picking Child Up *

You may list more than one.

First Name

Last Name

My child is allowed to leave on their own at the end of class.

Yes my child can leave on their own.

No, the name(s) listed above is who will be picking my child up.