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2023 Winter Afternoons Form
Sam Faeder
2022-12-06T12:14:13-05:00
Winter 2023 After-School Afternoons Form
Parent Name
*
First
Last
Child Name
*
First
Last
Child's DOB
*
MM slash DD slash YYYY
Child's School
*
Primary Email Address
*
Additional Email Addresses
Please separate with a comma.
Phone Number
*
If Adding a Second Child (Name, DOB)
Additional Notes (Allergies, Background Information)
Authorized Adults for Pick Up
*
Please list all adults authorized for end-of-day pick up (besides the registering parent). Please separate with a comma.
1 Weekday / Week (11 Weeks)
Quantity
Price:
$1,295.00
Quantity
Put "1" in the quantity field
2 Weekdays / Week (11 Weeks)
Quantity
Price:
$1,195.00
Quantity
Put "2" in the quantity field.
3 Weekdays / Week (11 Weeks)
Quantity
Price:
$1,095.00
Quantity
Put "3" in the quantity field.
4 Weekdays / Week (11 Weeks)
Quantity
Price:
$995.00
Quantity
Put "4" in the quantity field.
5 Weekdays / Week (11 Weeks)
Quantity
Price:
$895.00
Quantity
Put "5" in the quantity field. (Please note this total includes the prorated Monday.)
Multi-Sports After-School: Select Your Weekday(s)!
Monday (SOLD OUT)
Tuesday (SOLD OUT)
Wednesday (LAST SPOTS AVAILABLE - SELECT AGE GROUPS ONLY)
Thursday (LAST SPOTS AVAILABLE - SELECT AGE GROUPS ONLY)
Friday
If you are registering siblings, all discounts will be applied after registration is complete.
Mindful Sports Flag-Football League: Select Your Weekday(s)!
Monday
Tuesday
Wednesday
Thursday
Children are welcome to try the Flag-Football League, there is no obligation to attend. All kids can also join our multi-sports classes.
Night Sports or Indoors?
*
Night Sports
Indoors @ 5:00pm
When it starts to get dark after 5:00pm, children can stay outside for Night Sports (headlamps, vests, glow-in-the-dark equipment) or come indoors. Please select your preference! Please note that when the temperature is below our threshold, all children will go indoors. Changes can be made.
COVID Vaccination Card
*
YES - VACCINE CARD WAS PREVIOUSLY UPLOADED
No, Uploading Card Below
Mindful Sports requires COVID vaccination for all children who use our private indoor facilities. Please click "YES - VACCINE CARD WAS PREVIOUSLY UPLOADED" if you've already sent us your card in previous seasons. Or "No, Uploading Card Now," and please upload below.
File
Max. file size: 300 MB.
Total
$0.00
Consent
*
I agree to the waiver of liability
I, the parent/guardian registering my child[ren] for a Mindful Sports program, am aware that participation in youth sports programs has some inherent risks and injury can occur. On rare occasions these injuries can be serious. In consideration of my child[ren] being allowed to participate in Mindful Sports programs, I, the parent/guardian, assume the risk of participation and agree not to hold Mindful Sports, the program directors, coaches, assistant coaches, or owner responsible for any and all injuries caused by or resulting from participating in Mindful Sports Programs. This also includes the walking transportation to/from Mindful Sports activities and locations. I understand that this program takes place during the fall months and includes outdoor play. I agree to assume all risks of outdoor play during the fall time, including cold weather, and understand that additional information can and should be requested from the program if needed. I understand that this program is taking place during a time when Coronavirus presents additional risk. I understand these risks. In the event of any injury or illness caused directly or indirectly by Coronavirus or any such virus, I will not hold Mindful Sports, and all associated parties previously mentioned, responsible. By selecting the "I agree" button above, I state that I understand this description and agree.
Consent
I agree to the permission for photographic likeness
I, the parent/guardian registering my child[ren] for a Mindful Sports program, authorize the use of pictures of the above-named child participant to be posted on the Mindful Sports website or advertising media published by Mindful Sports
Credit Card
*
Card Details
Cardholder Name
Billing Address
*
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Address Line 2
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