Winter Camp 2023 Registration

Parent Name*

First Last

Child Name*

First Last

Child's DOB*

Email Address*

Phone*

Allergies/Special Needs/Notes

If Adding a Second Child (Name, DOB)

If you would like to add a sibling(s) registration, please do so here, along with their DOB and week(s) attending. We will contact you for additional payment, with all sibling discounts for all children, at a later date.

Authorized Adults*

Please list all authorized adults for pick up

Friday, March 10th (Winter Families on Friday ONLY)

Price: $50.00

If you are registered for a PICK UP Friday in the Winter After-School Program that you are choosing the DOE Half Day Camp date, select this option. If you are registered for 2+ pick up weekdays/week in the Winter Program, or have siblings in the pick up program, your fees are waived for Half Day dates on THAT/THOSE weekday(s) and no payment is needed. If you are registering for a date that is NOT on your weekday(s) in the Winter Program, please contact us for full day registration.

Total

$0.00

COVID Vaccine Card Upload

Max. file size: 300 MB.

If you haven't sent us your child's vaccine card in previous seasons, please do so here

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

Winter Camp 2023 Form