Spring 2021 Registration After-School

Parent Name*
First Last
Child Name*
First Last
Child's DOB*
MM slash DD slash YYYY
Child's School*
Email Address*
Phone Number*
What day is your class?
Who is your group host parent?
45-Minute Session (8 Sessions) (Ages 3-4) (4+ Children) Quantity
Price: $395.00
One after-school program, one day-per-week, eight total sessions. Registration for one (1) child.
1-Hour Session (8 Sessions) (4+ Children) Quantity
Price: $395.00
One after-school program, one day-per-week, nine total sessions. Registration for one (1) child.
1.5 Hour Session (BASIS) (9 Sessions) Quantity
Price: $625.00
One after-school program, one day-per-week, nine total sessions. Registration for one (1) child.
1.5 Hour Session (GR Wednesday) (9 Sessions) Quantity
Price: $595.00
One after-school program, one day-per-week, nine total sessions. Registration for one (1) child.
1.5 Hour Session (Luria Friday) (9 Sessions) Quantity
Price: $595.00
One after-school program, one day-per-week, nine total sessions. Registration for one (1) child.
Luria Friday Sibling Registration (9 Sessions) Quantity
Price: $940.50
One after-school program, one day-per-week, nine total sessions. Registration for two (2) children.
Luria Friday Sibling Registration (9 Sessions) (3 children) Quantity
Price: $1,395.00
One after-school program, one day-per-week, nine total sessions. Registration for three (3) children.
Semi-Private 1-Hour Session (9 Sessions) (2 Children) Quantity
Price: $720.00
One after-school program, one day-per-week, seven total sessions. Registration for one (1) child.
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 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