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2023 Winter Classes Form
Sam Faeder
2022-12-06T12:14:56-05:00
Winter 2023 After-School Classes Form
Parent Name
*
First
Last
Child Name
*
First
Last
Child's DOB
*
MM slash DD slash YYYY
Child's School
*
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 authorized adults for pick up (besides the registering parent). Please separate with a comma.
Early Pre-K / Ages 3-4 (10 Sessions) (45-Minute Sessions)
Quantity
Price:
$595.00
Quantity
One after-school program, one day-per-week, ten total sessions. Registration for one (1) child.
Pre-K / Ages 4-5 (10 Sessions) (1-Hour)
Quantity
Price:
$595.00
Quantity
One after-school program, one day-per-week, ten total sessions. Registration for one (1) child.
K-5th Grade (10 Sessions) (1.5-Hour Session)
Quantity
Price:
$750.00
Quantity
One after-school program, one day-per-week, ten total sessions. Registration for one (1) child.
Multi-Sports After-School: Select Your Weekday(s)!
Monday
Tuesday
Wednesday
Thursday
Friday
Please note, "After-School Classes" and the Mindful Sports League are outdoors only and will be postponed/rescheduled in the case of severe inclement weather. For more information, please contact us at contact@mindful-sports.com
Flag-Football League: Select Your Weekday(s)!
Monday
Tuesday
Wednesday
Thursday
Please note, the Mindful Sports Flag-Football League is only for K-5th Graders.
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 winter months and includes outdoor play. I agree to assume all risks of outdoor play during the winter time, 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 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
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