PS770 After School - Mindful Sports

Parent Name*

First Last

Child Name*

First Last

Child's DOB*

Email Address*

Phone*

What Date(s) Are You Attending?*

If Adding a Second Child (Name, DOB)

Allergies/Special Needs/Notes

2-Hour Session (5 Weekdays/Week)

Price: $575.00

Put "5" in the quantity field

1.5-Hour Session (5 Weekdays/Week)

Price: $495.00

Put "5" in the quantity field

1-Hour Session (5 Weekdays/Week)

Price: $379.00

Put "5" in the quantity field

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. 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*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PS 770 After-School