Lift Acro Evolution Registration

Lift Acro Evolution Preschool Registration January 14-March 4 2023 9:30am

One form required per student. Session 2 (8 weeks) begins January 14th and finishes March 4th. Session is $120+HST
Student 1 Full Name*

First Name Last Name
Date of Birth*

DayMonth Year
Date
Parent Name*

First Name Last Name
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number*

Area Code Phone Number
Is this a mobile number?*
Alternate Phone number (for emergency)*

Area Code Phone Number
Parent E-mail*
Please include any medical conditions (physical, mental, emotional or other) that may be helpful to the instructor in planning meaningful classes or to better help the student progress. Please include things like ADHD, even if managed, medicated, or undiagnosed by a medical professional. We have tools and strategies that may help your child with a more meaningful class.

Registration is partially refundable before start of session. A $20 administrative fee will be held for refunds. After start of session classes are NOT refundable.

Preschool Registration$120.00CAD

Subtotal $0.00CADTax $0.00CADTotal $0.00CAD

Credit Card

By hitting submit and electronically signing, I agree that I am the parent or legal guardian of the above named student, and/or am over the age of 18.

I am participating in classes through Lift Acro Evolution. I recognize that the classes I am registering for require physical exertion which may be strenuous and may cause physical injury. I am fully aware of the hazards and risks involved.
I understand it is my responsibility to consult a physician prior to and regarding my participation in the class. I represent that I am physically fit and have no medical conditions which would prevent my full participation.

I agree to take full responsibility for any risks, injuries, or damages known or unknown which might incur as a result of participating in the class(es). I accept full responsibility for all costs of said medical care and any emergency treatments. Lift Acro Evolution or its' instructors will not be held responsible for the cost of any medical or dental care, or emergency treatments. I hereby waive all claims whatsoever in connection with such medical treatments.
I knowingly and voluntarily waive any claim I may have against Lift Acro Evolution, any faculty members, or contractors, for injury and/or damage that I may sustain as a result of participating in class(es).

Staff members are First Aid qualified. I agree to allow certified instructors to perform First Aid if necessary. I agree to to allow instructors to call the Emergency Number (911), and me (or my child) transported by ambulance as required to seek medical attention.

I am aware of my responsibilities to protect myself and others against the spread of COVID-19. If I show symptoms of the virus (see the Renfrew County Health Unit webpage for a complete list of possible symptoms), I agree to inform my instructor IMMEDIATELY upon onset of the symptoms, and will not enter the facility for any reason. I agree to take the self assessment on the Government of Ontario webpage prior to each day of classes
https://covid-19.ontario.ca/self-assessment/

I agree to review and accept the policies and regulations of Lift Acro Evolution prior to enter in the facility.

I agree to pay monthly instalments as outlined on our website (www.liftacroevolution.com) for the classes I am registering for. Payment is due on the 1st of each month in which classes are held.

Missed classes will not be refunded. Registration fee is non-refundable. Classes paid for by credit card are subject to non-refundable credit card fees.

I grant permission for Lift Acro Evolution and the instructors hired by contract, to take photos and videos of me/my child for promotional purposes. The videos and photographs may be used in the future by Lift Acro Evolution for advertising and promotion.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
Signature*

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Lift Acro Evolution Preschool Registration January 14-March 4 2023 9:30am

Credit Card