Spring 2022 Afternoons Registration Form

Parent Name*

First Last

Child Name*

First Last

Child's DOB*

Child's School*

Email Address*

Phone Number*

If Adding a Second Child (Name, DOB)

Additional Notes

1 Weekday / Week (11 Weeks)

Price: $1,295.00

Put "1" in the quantity field

2 Weekdays / Week (11 Weeks)

Price: $1,195.00

Put "2" in the quantity field.

3 Weekdays / Week (11 Weeks)

Price: $1,095.00

Put "3" in the quantity field.

4 Weekdays / Week (11 Weeks)

Price: $995.00

Put "4" in the quantity field.

5 Weekdays / Week (11 Weeks)

Price: $895.00

Put "5" in the quantity field. (Please note this total includes the prorated Monday.)

Select Your Day(s) / Week*

Monday
Tuesday (SOLD OUT)
Wednesday (SOLD OUT)
Thursday (SOLD OUT)
Friday

If you are registering siblings, all discounts will be applied after registration is complete.

Would Your Child[ren] Like to Join the Mindful Sports Baseball League?

Tuesday (SOLD OUT)
Wednesday (SOLD OUT)
Thursday (SOLD OUT)

The Mindful Sports Baseball League is in lieu of the traditional after-school multi-sports class. There are no additional fees, and children can always change their minds! This selection is not binding.

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 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

Spring 2022 After-School Afternoons Form