YPA Registration

YPA REGISTRATION

You must complete a registration form for each child | Contact | 602.535.2565
CHILD INFORMATION
FULL NAME

First NameLast Name
MIDDLE INITIAL
SUFFIX (JR,. ETC.. )
NICKNAME
AGE
Date of Birthday
GENDER
RACE
SCHOOL NAME
GRADE
CELL PHONE
1ST ADDRESS

Street Address, apt/unit number

Street Address Line 2

CityState / Province

Postal / Zip Code
GATE CODE
2ND ADDRESS

Street Address, apt/unit number

Street Address Line 2

CityState / Province

Postal / Zip Code
GATE CODE
CHILD EMERGENCY INFORMATION
CONTACT NAME (NOT GUARDIAN)

First NameLast Name
RELATIONSHIP TO CHILD
brother, friend..
CONTACT'S PHONE NUMBER
BEHAVIORS/DISABILITIES
list all disabilities & behaviors
ALLERGIES
list all allergies
MEDICATIONS
list all medications
HEALTH INSURANCE
list the name of insurance
1ST PARENT/GUARDIAN INFORMATION
NAME

FIRST NAMELAST NAME
RELATIONSHIP TO CHILD
MARITAL STATUS
OCCUPATION
TITLE
ADDRESS (if different from Childs)
Street Adress, apt/unit number, City State Zip Code
CELL PHONE
WORK PHONE
EMAIL
example@example.com
2ND PARENT/GUARDIAN INFORMATION
Name

FIRST NAMELAST NAME
RELATIONSHIP TO CHILD
MARITAL STATUS
OCCUPATION
TITLE
ADDRESS (if different from Childs)
Street Adress, apt/unit number, City State Zip Code
CELL PHONE
WORK PHONE
EMAIL
example@example.com
LIABILITY INFORMATION
I, first & last name GIVE MY PERMISSION FOR MEDICAL EMERGENCY TREATMENT OF MY CHILD FOR ILLNESS OR ACCIDENT, IF I CANNOT BE CONTACTED
AGREE print initial DISAGREEprint initial
I, first & last name GIVE FULL CONSENT TO PUBLISH ALL PHOTOGRAPHS, MOTION PICTURES AND/OR VIDEOS FOR ANY AND ALL YPA RELATED EXHIBITIONS, PUBLIC DISPLAYS, PUBLICATIONS AND/OR ADVERTISING PURPOSES WITHOUT LIMITATION OR RESERVATION
AGREEprint initial DISAGREEprint initial
I, first & last name agree and attest that I have SOLE LEGAL CUSTODY RIGHTS OFchild first & last name & able to make ALL LEGAL DECISIONS REGARDING MY CHILD
academy home/NA
*If a Foster Home or Foster Parent (please provide copy of NOTICE TO PROVIDER)
PARENT/GUARDIAN SIGNATURE (First & Last)

Clear
I GIVE FULL CONSENT TO PUBLISH ALL PHOTOGRAPHS, MOTION PICTURES AND/OR VIDEOS FOR ANY AND ALL YPA RELATED EXHIBITIONS, PUBLIC DISPLAYS, PUBLICATIONS AND/OR ADVERTISING PURPOSES WITHOUT LIMITATION OR RESERVATION & ALSO AGREE NO COMPENSATION WILL BE PAID FOR ANY OF THE AFOREMENTIONED:
AGREE/DISAGREE

Yes, I agreeNo, I do not agree
PARENT/GUARDIAN SIGNATURE (First & Last)

Clear
WAIVER OF LIABILITY INFORMATION
Young People's Academy, LLC (KYDS/ACADEMY VILLAS) shall not be liable to YPA customer/client on account of any personal injuries and/or any unforeseen death sustained by YPA customer/client in performance of playing and/or not keeping and maintaining their personal safety on any YPA facilities hereunder.
BY SIGNING THIS ENTIRE FORM, I ACKNOWLEDGE THAT HAVE READ, UNDERSTAND & AGREE AND CERTIFY THAT ALL INFORMATION DOCUMENTED IS ACCURATE TO THE BEST OF MY KNOWLEDGE (including WAIVER OF LIABILITY PAGE & DROP OFF/PICK UP PAGE)
Parent/Guardian, shall indemnify and hold Young People's Academy, LLC harmless from all liability for personal injuries directly related to the playing and/or being in the presence in any YPA facility (this may include any games such as water ballooning, laser tag, dodgeball, nerf wars, swimming, field trips etc ).
Name First & Last
PARENT/GUARDIAN SIGNATURE (First & Last)

Clear
Customer/client is recommended to have personal insurance coverage for all injuries, illnesses or fatalities. *YPA/KYDS VILLAS will not be held responsible for any of your or your child's personal items that are lost, stolen or damaged during your and/or your child's stay/visit with YPA/KYDS VILLAS. Review the YPA handbook for items NOT to bring to YPA facilities (please do not send your child to YPA/KYDS VILLAS with expensive jewelry, money, games, toys etc
I, understand and agree that I am a YPA customer/client

First NameLast Name
My, child's (name) is also a YPA customer/client

First NameLast Name
PARENT/GUARDIAN SIGNATURE (First & Last)

Clear
PICK-UP & DROP-OFF INFORMATION
The following persons (NOT INCLUDING YOURSELF) have my permission to pick up my child from YPA/KYDS VILLAS facilities.
NAME

First NameLast Name
PHONE NUMBER
RELATIONSHIP
ID/Driver License

Browse Files
Upload a clear picture of their state ID/driver license Cancelof
NAME

First NameLast Name
PHONE NUMBER
RELATIONSHIP
ID/Driver License

Browse Files
Upload a clear picture of their state ID/driver license Cancelof
NAME

First NameLast Name
PHONE NUMBER
RELATIONSHIP
ID/Driver License

Browse Files
Upload a clear picture of their state ID/driver license Cancelof
IMPORTANT: WE will NOT speak to or give out ANY INFORMATION to anyone over the phone about your child if they DO NOT have and/or provide YPA/ Kyds/Academy Villas with this special 5 DIGIT ACCESS CODE that you've have selected!

NO EXCEPTIONS
SELECT A 5 DIGIT ACCESS CODE
PHOTO RELEASE

I authorize & give 100% permission of my child/children to have their photo or video taken during activities & events while at the Kyds Villas (KV) {a Young People's Academy/YPA company} for the use of (not limited to) KV social media, KV vlogs, KV YouTube programs, KV interviews, KV publications, KV exhibits, KV/YPA website, KV podcasts etc and to promote/market the Kyds Villas programs and functions in good conduct and appropriate and only approved by YPA/Kyds Villas. I also, authorize, agree and understand that my child/children's photo or video (that is or was taken at the KYDS VILLAS/YPA facility or event) may possibly be shown or displayed or shared on other social media platforms or media for the promotion/advertisement of services and programs approved by KYDS VILLAS/YPA. I am also aware that if at any time I wish to change my mind and start/stop my authorization of my child/children photo or video being used for the KYDS VILLAS/YPA for promotion and advertisement, I agree to submit in writing directly to KydsVilla71@gmail.com and use their return email as confirmation that my authorization has been verified.
Photo Release

Yes, I agreeNo, I disagree
NO REFUND POLICY

I understand that if I make a reservation online and do not show (or fail to drop-off my child/children at the reservation time) after 15 minutes of my reservation start time, I understand and agree that I will not receive a refund. Here at YPA/Kyds Villas we value your time as well as ours. We reserve a certain number of time slots for all children (in preparation and planning for all the daily activities/events) and would never want to hold a slot for a "no show" when that time slot could have been filled with another child on the wait list. NO REFUND POLICY

MEDICATION POLICY

I agree and understand that if my child requires medication given during the time and hours he/she is at YPA/Kyds Villas during their reservation, that I know to ONLY bring the EXACT number of pills/prescription for the reservation time (no more/no less)

ALL MEDICINE MUST BE IN THE/IN A PHARMACY BOTTLE WITH PHARMACY LABEL ON IT WITH YOUR CHILDS NAME, DOCTORS NAME, DOCTORS NUMBER/PHARMACY NUMBER, RX #, DOSAGE, DRUG NAME AND DATE PRESCRIBED (no exception)!
I, agree to the no refund policy and medication policy

Yes
EMERGENCY POLICY

I agree and understand that in the event my child/children requires immediate medical attention that I authorize YPA/Kyds Villas to call 911 and assist (logistically) in the transfer to a nearest ER in the event that I cannot make it back to the facility in enough time to transport my child/children myself. I also agree and authorize YPA/Kyds Villas to provide basic first aid in case my child/children incur an unfortunate injury. In the event my child/children chokes or experiences heart or lung failure, I authorize YPA/Kyds Villas to perform basic first aid/CPR with the direction of the 911 dispatch (all YPA/Kyds Villas staff/YCPAs are certified in CPR/First Aid for the safety of everyone at YPA/Kyds Villas, I agree and understand that I must notify YPA/Kyds Villas if my child is sick or has come in direct contact with anyone known with an infectious disease and I agree to keep my child/children home until they are medically cleared.
I, agree to the emergency policy

Yes
If medical care is needed, call: HEALTH CARE PROVIDER NAME
In case of an emergency, the following people CANNOT remove my child from YPA RESORT/KYDS VILLAS facilities:
IMMUNIZATION/SHOT RECORD INFORMATION

1. ATTACH A COPY OF THE CHILD'S SHOT RECORDS

2. If your child is not a participant in immunizations, parent must attach a copy of an updated "EXEMPTION AFFIDAVIT FORM' for religious, medical or other..
YES, I HAVE ATTACHED

A copy of shot recordsA copy of exemption affidavit form
SHOT RECORDS

Browse Files

Cancelof
EXEMPTION AFFIDAVIT FORM

Browse Files

Cancelof
I have successfully read, agree and fully understand 100% all the above pages (including this 8th page) and agree to all rules and policies of YPA and Kyds/Academy Villas. I understand that this agreement and application can be terminated at any time should any caused safety measures be compromised from myself, my child/children or any other persons I authorize to drop off or pick up, to the company of YPA/Kyds/Academy Villas.
AGREE*

Yes, I agree
Parent/Guardian*

First NameLast Name
Driver License/ State ID
Parent/Guardian Signature *

Clear

	Date of Birth	Age	Favorite Color	Favorite Snack	Favorite Activity
Girl
Boy

YPA REGISTRATION

CHILD INFORMATION

CHILD EMERGENCY INFORMATION

LIABILITY INFORMATION

I GIVE FULL CONSENT TO PUBLISH ALL PHOTOGRAPHS, MOTION PICTURES AND/OR VIDEOS FOR ANY AND ALL YPA RELATED EXHIBITIONS, PUBLIC DISPLAYS, PUBLICATIONS AND/OR ADVERTISING PURPOSES WITHOUT LIMITATION OR RESERVATION & ALSO AGREE NO COMPENSATION WILL BE PAID FOR ANY OF THE AFOREMENTIONED:

BY SIGNING THIS ENTIRE FORM, I ACKNOWLEDGE THAT HAVE READ, UNDERSTAND & AGREE AND CERTIFY THAT ALL INFORMATION DOCUMENTED IS ACCURATE TO THE BEST OF MY KNOWLEDGE (including WAIVER OF LIABILITY PAGE & DROP OFF/PICK UP PAGE)

PICK-UP & DROP-OFF INFORMATION