AMAzing Youth LLC Full Program Registration

AMAzing Youth LLC Registration

Thank you for choosing AMAzing Youth LLC! Please complete the registration form below to enroll your child in our programs. There is a $50.00 registration fee per child. We look forward to supporting your child’s educational and enrichment journey.
Student Information
1st Child's Name*

First NameLast Name
1st Child's DOB*

MonthDayYear
Date
1st Child's Grade Level*
1st Child's School*
Child is registering for (select all that apply)*

Student Success CoachingHomeschool Enrichment Program: Project - Based Learning ClassesHomeschool Enrichment Program: Homeschool Enrichment AcademyEnrichment Program - Book ClubEnrichment Program - Coding ClubEnrichment Program - Creative Club (Arts & Crafts)Enrichment Program - Creative Writing ClubEnrichment Program - DanceEnrichment Program - Little Ladies & Gents ClubEnrichment Program - Mixed Martial Arts ClubEnrichment Program - Theatre ClubEnrichment Program - Young Entrepreneurs ClubAfter-School Reading ProgramAfter-School Math Program
Child 2 Name

First NameLast Name
2nd Child's DOB

MonthDayYear
Date
2nd Child's Grade Level
2nd Child's School
Child is registering for (select all that apply)

Student Success CoachingHomeschool Enrichment Program: Project - Based Learning ClassesHomeschool Enrichment Program: Homeschool Enrichment AcademyEnrichment Program - Book ClubEnrichment Program - Coding ClubEnrichment Program - Creative Club (Arts & Crafts)Enrichment Program - Creative Writing ClubEnrichment Program - DanceEnrichment Program - Little Ladies & Gents ClubEnrichment Program - Mixed Martial Arts ClubEnrichment Program - Theatre ClubEnrichment Program - Young Entrepreneurs ClubAfter-School Reading ProgramAfter-School Math Program
3rd Child's Name

First NameLast Name
3rd Child's DOB

MonthDayYear
Date
3rd Child's Grade Level
3rd Child's School
Child is registering for (select all that apply)

Student Success CoachingHomeschool Enrichment Program: Project - Based Learning ClassesHomeschool Enrichment Program: Homeschool Enrichment AcademyEnrichment Program - Book ClubEnrichment Program - Coding ClubEnrichment Program - Creative Club (Arts & Crafts)Enrichment Program - Creative Writing ClubEnrichment Program - DanceEnrichment Program - Little Ladies & Gents ClubEnrichment Program - Mixed Martial Arts ClubEnrichment Program - Theatre ClubEnrichment Program - Young Entrepreneurs ClubAfter-School Reading ProgramAfter-School Math Program
4th Child's Name

First NameLast Name
4th Child's DOB

MonthDayYear
Date
4th Child's Grade Level
4th Child's School
Child is registering for (select all that apply)

Student Success CoachingHomeschool Enrichment Program: Project - Based Learning ClassesHomeschool Enrichment Program: Homeschool Enrichment AcademyEnrichment Program - Book ClubEnrichment Program - Coding ClubEnrichment Program - Creative Club (Arts & Crafts)Enrichment Program - Creative Writing ClubEnrichment Program - DanceEnrichment Program - Little Ladies & Gents ClubEnrichment Program - Mixed Martial Arts ClubEnrichment Program - Theatre ClubEnrichment Program - Young Entrepreneurs ClubAfter-School Reading ProgramAfter-School Math Program
Session Preferences
Preferred Start Date*

MonthDayYear
Date
Preferred Days/Times*

MondayTuesdayWednesdayThursdayMorningAfternoonEvening
Preferred Setting*
Parent/Guardian Information
Parent/Guardian's Name*

First NameLast Name
Relationship to Child(ren)*
Parent/Guardian's Phone Number*

Area CodePhone Number
Parent/Guardian's Email*
example@example.com
Family Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Relationship to Child(ren)*
Emergency Contact's Phone Number*

Area CodePhone Number
Medical Information
Does child(ren) have any allergies or medical conditions we should be aware of?*
Does child(ren) currently take any medications?*
Does your child(ren) have any special food restriction? (i.e. vegetarian, vegan, gluten free, etc.)*
I fully understand that AMAzing Youth LLC's Instructors, employees, and agents are not physicians or medical practitioners of any kind. I understand that should a health problem arise, I will be notified but if I cannot be reached by telephone I consent to emergency medical treatment, which may include temporary first aid, and if deemed necessary by Amazing Youth LLC's staff to call emergency services.
Medical Information: Parent/Guardian Signature*

Clear
Learning and Behavioral Information
Does child(ren) have any learning or behavioral needs that require special accommodations?*
Parental Liability Waiver
The Undersigned, Being a Parent or Guardian of the above named minor(s) releases AMAzing Youth LLC, henceforth referred to as "Amazing Youth", its representatives, agents, servants, and employees from liability for any injury to said minor, resulting from any cause whatsoever occurring to said minor at any time while attending Amazing Youth Center or participating in any Amazing Youth program or activity, including travel to and from the center and any field trips, excepting only injury or damage resulting from willful acts of such representatives, agents, servants and employees. Amazing Youth is also released of any expenses resulting from the injury. In some of our programs, your child will have the opportunity to participate in physical activities, including but not limited to running, stretching, dancing, and jumping. Where necessary, Amazing Youth will provide trained staff who will conduct these activities in the safest manner possible.

I, for myself, for My Child, My Child’s heirs, executors, administrators and assigns, hereby release, waive, relinquish, and forever discharge and hold harmless Amazing Youth from any and all claims, demands, damages, actions and causes of action, including, but not limited to, claims, demands, damages, actions and causes of actions for personal or bodily injury, damage or loss of property, or death, which I, My Child, My Child’s heirs, executors, administrators, and/or assigns have or may ever have arising out of, by reason of, or in any manner related to My Child’s participation in Amazing Youth's Programs and its related activities on Amazing Youth’s Premises. Further, I hereby agree that under no circumstances will I, for myself, for My Child, My Child’s heirs, executors, administrators and/or assigns, prosecute or present any claim for personal or bodily injury, damage or loss of property, or death against any or all of Amazing Youth. It is my intention by this instrument to exempt and relieve Amazing Youth from any and all liability arising out of My Child’s participation in Amazing Youth's Programs, including, but not limited to, liability for personal or bodily injury, damage or loss of property, or death. I further expressly agree that this Release, Waiver of Liability and Assumption of Risk is intended to be as broad and as inclusive as the laws of the State of Florida will allow, and that if any portion thereof is held to be invalid, it is agreed that the balance shall, notwithstanding the invalid portion, continue in full force and effect. I further represent and state that I am not relying on any oral or written representation or statements made by Amazing Youth. I further agree that this Release, Waiver of Liability and Assumption of Risk shall be governed by and interpreted in accordance with the laws of the State of Florida. In signing this Release, Waiver of Liability and Assumption of Risk, I acknowledge and represent: (i) that I have read and understand it; (ii) that I sign it voluntarily and for full and adequate consideration, fully intending to be bound by the same; (iii) that I am at least eighteen (18) years of age and fully competent. I understand that this is a legal document which is binding on me, my heirs, executors, administrators, and assigns and on those who may claim by or through me.
Parental Liability Waiver: Parent/Guardian Signature*

Clear
Parental Image/Video Release
It is our practice to seek parental consent before including your child’s photograph and/or recorded video on Amazing Youth LLC's web page, social media, or in any publications, or to release any images to the media, for the purpose of showcasing the accomplishments of our students and staff. To release or include your child’s image in any project, we must have your consent. Please review the three sections below. This form will be good for the duration of your child’s participation in Amazing Youth LLC's Programs.

Amazing Youth LLC has my permission to publish a photograph and/or video image of my child, for the following:

Section I: Internal Use of Photographs and Video

Student photographs/video images may be taken for internal use such as student recognition bulletin boards, newspapers and newsletters, projects, etc.
Please check one*

I grant permission to use my child(ren)'s photograph/video as described above.I DO NOT grant permission to use my child(ren)'s photograph/video as described.
Section II: External Use of Photographs and Video

Student images may be used for external publications such as press releases, print ads, or other publications related to my child’s participation in Amazing Youth LLC'S programs.
Please check one*

I grant permission to use my child(ren)'s photograph/video as described above.I DO NOT grant permission to use my child(ren)'s photograph/video as described.
Section III: Web Page and Social Media Use of Photographs and Video

Student images may be used for Amazing Youth LLC website and social media pages with the understanding that the child’s full name will not be published on the Internet when an image is posted. Last names of students will NOT be used on web page or social media projects.
Please check one*

I grant permission to use my child(ren)’s photograph/video as described above.I DO NOT grant permission to use my child(ren)’s photograph/video as described.
AMAzing Youth LLC Policies and Procedures
Attendance

It is imperative that students arrive on time and attend all courses they have registered for. If 2 or more courses are missed the student may be dropped from the course to make space for students on the waitlist. If student misses a course or is dropped from a course payment will still be due for the billing cycle and no refund will be provided.

Food and Drink

Outside Food and drinks are not permitted in the Center with the exception of a covered water bottle. No gum or candy allowed in center either.

Dress

Comfortable and non revealing clothes should be worn.

Certain Enrichment Programs (Mixed Martial Arts, Dance, etc. have a dress policy that will be found in the Parent Information Packet for the program).

Cancellation

Amazing Youth LLC reserves the right to cancel a course/class/club with 24 hour advance notice. If a course/class/club is cancelled, an acceptable replacement will be provided.

If student needs to miss a session 24 hour advance notice is required. Payment will still be due if 24 hour advance notice is not provided.

Payment

Payment is due by the 8th of the month in which the billing cycle is due. If payment is not received by the 8th of the month, payment is considered late. A $5 late fee is applied each day until payment is made in full. If payment is not received by the 8th of the month, student(s) will not be allowed to participate in any further courses/classes/clubs or receive related materials until program payment and late fees are paid in full.

Refunds

No refunds will be provided.

Student Code of Conduct and Discipline

This Code of Conduct is designed to promote a healthy and safe environment that encourages the social and emotional development of all students. A disciplined environment is essential to meeting these ends. This Code of Conduct is intended to enable the development of self-discipline in all students. This is done through both positive and negative recognition and consequences of behavior as necessary to encourage appropriate behavior and discourage inappropriate behavior that would intefere with the goals and missions of the program.

Student Responsibilities

1. Students are responsible for respecting themselves through their behavior and self control.

2. Students are reponsible for demonstrating respect for others by use of appropriate language, avoiding profanity; racial and ethnic slurs; or any otherwise denigration of others through other verbal and nonverbal language or communication.

3. Students shall be responsible for demonstrating respect of all property.

4. Students shall be responsible for understanding and abiding by specific program rules.

5. Students have a responsibility to speak to an adult when they think something is wrong, are being hurt, or others are being hurt.

6. Students shall be responsible for using good judgement.

7. Students are responsible for putting in their best effort.

Positive Recognition
- Informal Recognition
- Formal Recognition
- Rewards
Disciplanary Actions
- Informal Reprimand
- Time Out
- Formal Reprimand
- Phone Call to parent to be picked up
- Temporary dismissal from program
- Permanant dismissal from program
To protect the safety of all students, AMAzing Youth LLC have no-tolerance policies that could immediately result in students being sent home, dropped from program, and/or referral to law enforcement. These policies include but are not limited to:

1. Use of violence

2. Bullying or any type of harrassement

3. Possession of weapons, replicas, or items that could be used as weapons
I agree that my child(ren) and I will abide by all the policies and procedures outlined above*

Agree
Policies and Procedures: Parent/Guardian Signature*

Clear

My Products

Registration Fee$50.00

Number of Children
Item subtotal:$0.00

Subtotal $0.00Tax $0.00Total $0.00

Payment Methods

Credit Card

Apple Pay

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AMAzing Youth LLC Registration

Student Information

Session Preferences

Parent/Guardian Information

Emergency Contact Information

Medical Information

Learning and Behavioral Information

Parental Liability Waiver

Parental Image/Video Release

AMAzing Youth LLC Policies and Procedures

Payment Methods