Relax Kids Registration Form

Our Thoughts are Like Seeds In-Person Class

870 West 300 North, Kaysville, UT
Our Kids Empowered Registration Form

Our Thoughts are Like Seeds Class
Childs Name

First Name Last Name
Age
Parent/Guardians Name

First Name Last Name
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email
example@example.com
Emergency Numbers
Contact Name

First Name Last Name
Relationship To Child
Phone Number

Area Code Phone Number
Contact Name

First Name Last Name
Relationship To Child
Phone Number

Area Code Phone Number
Does your child have any special needs we should know about?
Please give brief detail
Does your child have any allergies?
Please give detail
What would you like your child to learn in our class? Is there anything you would like us to focus on with them?
Do we have permission to use photos of your child online and offline for marketing purposes only?
How did you hear about Our Kids Empowered?
I individually as a parent/guardian of the child identified above hereby agree to the following:

Parent’s Responsibilities: Our Kids Empowered takes all reasonable care to ensure that its classes are fun and safe. However, I understand that as with any activity, there is some risk of injury. In the event of an emergency and in my absence, I agree to 911 being contacted.

Please be prompt in picking up your child from class.

My child’s protection.

As far as is permitted under Local Law, I assume the above risks and accept responsibility for any injury sustained by my child. I further discharge and hold harmless Our Kids Empowered including its owners and teachers from any liability arising from any injury to my child or other persons or property caused by my child’s participation in the class if that injury is caused either by my or my child’s fault; or by a third party unconnected with Our Kids Empowered.
Which class time do you prefer? Dates are March 18, March 25, April 8, April 15, April 22, May 6

6:00-6:50 PM 7:00-7:50 PM
Signature
DateTime
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Our Thoughts are Like Seeds In-Person Class

Our Kids Empowered Registration Form