Carla Cavellucci March 30, 2016 kids classes Registration - Kids Classes Carla Cavellucci March 30, 2016 kids classes STEP 2 KIDS CLASSES - MANDATORY REGISTRATION FORM Kids Classes - Registration Form Student type: * new student returning student Parent Name (1) * Parent Name (1) First Name Last Name Phone(1) * Phone(1) (###) ### #### Email(1) * Cell phone for text messages * Cell phone for text messages Please inform a cell phone # at which you can be reached in case we need to reschedule a class. (###) ### #### Parent Name(2) Parent Name(2) First Name Last Name Phone(2) Phone(2) (###) ### #### Email(2) Address * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact * Emergency Contact First Name Last Name Emergency Contact phone * Emergency Contact phone (###) ### #### Authorized Person Authorized Person If somebody other than Parent Name (1) and / or Parent Name (2) fields of this form will be responsible for picking up your child(ren), please inform name, relationship and phone number below. If it’s a single event, please send a written note (name and date) to the school via email, or hand it to Brazil Ahead on the occasion. First Name Last Name Authorized Person phone Authorized Person phone (###) ### #### Child's Name (1) * Child's Name (1) First Name Last Name Child's Date of Birth (1) * Child's Date of Birth (1) MM DD YYYY Child's Name (2) Child's Name (2) First Name Last Name Child's Date of Birth (2) Child's Date of Birth (2) MM DD YYYY Allergies? If yes, please explain * If more than one child, please include the name of the child. Fears or Phobias? If yes, please explain * If more than one child, please include the name of the child. WAIVER * I do hereby release (for myself, my executors and administrators) and wave any and all rights to claims for damages arising from illness, accident or occurrence caused by or as a result of my child’s participation or connection with Brazil Ahead (Brazil Ahead Language School, Inc.), its instructors, agents, representatives and/or facilities. Brazil Ahead Language School, Inc. shall not be held responsible by me for any loss or theft of my or my child’s personal items. If the parent(s) or person(s) authorized by the parent(s) fails to pick up a child at the time of the center’s daily closing, the center shall ensure that the child is supervised at all times and that staff members attempt to contact the parent(s) or person(s) authorized by the parent(s). I declare that I have read and understood the foregoing statement. I also declare that my child is in good health. STUDENT PHOTO RELEASE * I authorize Brazil Ahead to photograph, videotape or interview my child(ren) and to use such photos, videos or interviews, in some of its promotional materials, including web sites, Facebook pages and newsletters, flyers, posters and newspapers (when in group photos) and other materials in print, audio, electronic or visual media. In addition, I voluntarily waive any right, cause of action or demand of any kind whatsoever resulting from Brazil Ahead’s photograph or interview of my child(ren) from which any liability may or could accrue to Brazil Ahead. I also understand that Brazil Ahead will not give me or my child(ren) any compensation for using my child(ren)’s photograph or interview in its promotional materials. Thus, by signing this document, I waive any rights to any compensation now or in the future. I agree I do NOT agree - please do not photograph my child. I understand this will exclude my child from progress videos, photo updates on your website etc. I do ALSO agree - that my child photos, videos or interviews might be used, as well as the name of my child, in any of its promotional materials, including its brochures and advertisements materials in print, audio, electronic or visual media, when in group photos. SCHOOL POLICY * I have read the school policy below and agree to the terms and conditions contained in the policy. I am aware that the schedule I have chosen is subject to change and classes are not confirmed until at least four (4) students are enrolled. I agree Thank you! You will receive your confirmation shortly. Please review our school policy here. It contains IMPORTANT information regarding unused class hours, credits, refunds and scheduling.