Registration Form

Participant's Information*

First NameLast Name

Date of Birth*

MonthDayYear

Name of the School Student currently attends*

Teacher's Name or Classroom #*

Has your child been diagnosed with a medical condition or has a disability that you would like to share with us? *

Parent | Guardian*

First NameLast Name

Relationship to Student?*

Best Contact Number*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Choose Program(s) of Interest*

Do you allow your child to be photographed or video taped for promotional purposes of this program?*

YesNo

By hitting submit and electronically signing, I agree that I am the parent or legal guardian of the above named student, and am over the age of 18. I hereby give consent to FRIENDS ENRICHMENT PROGRAM to provide professional medical attention, customary medical/athletic training attention, transportation and emergency medical services as warranted in the course of my child’s participation in any activity contracted under FRIENDS ENRICHMENT PROGRAM. I am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses associated with participation in any of our programs. I further agree that FRIENDS ENRICHMENT PROGRAM along with employees, agents, officers and directors of this organization shall not be liable for any losses or damages occurring as a result of my child’s participation in any program. I understand my child may be used in photos/videos solely for the social media accounts of FRIENDS ENRICHMENT PROGRAM unless I state otherwise directly to an employee of FRIENDS ENRICHMENT PROGRAM. I also understand that there are no refunds and or transfers of payment for any program.

Parent or Guardian Signature*

Registration Form

WAIVER & RELEASE