Created - N - Love Studios Foundation, Inc. Program Registration Form

Registration Fee will be paid through Stripe immeditately after you have registered your child. YOU DO NOT need to have a Stripe account to use this system and may use credit card or debit card.

Only one child may be registered at a time.

Child's Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Birth Date*

MonthDayYear

Current Age:*

Gender:*

MaleFemale

Phone Number*

Area CodePhone Number

E-mail Address where you'd like to receive confirmation and information:*

AGES 8 - 17

Program will be held for one week from 9 AM - 1 PM

June 17 - June 21, 2024

Address:

Pompano Beach Cutural Center

50 Altantic BLVD, Pompano Beach, Fl. 33060

PROGRAM TUITION & PAYMENT: Program tuition fee is due in full.

NOTE: First 10 students register gets $40 off of $75

$75 (Residents & Non - Residents)

**NO REFUND POLICY**

Please note that refunds will not be issued for any classes under any circumstances

Child is registering for:*

Please provide at least 2 emergency conacts.

1st Emergency Contact Name*

First NameLast Name

1st Emergency Contact Relationship:*

1st Emergency Contact Daytime Phone Number:*

Area CodePhone Number

1st Emergency Contact Evening Phone Number if different:

Area CodePhone Number

2nd Emergency Contact Name:*

First NameLast Name

2nd Emergency Contact Relationship:*

2nd Emergency Contact Day Phone Number:*

Area CodePhone Number

2nd Emergency Contact Evening Phone Number if different:

Area CodePhone Number

Please list other important emergency contacts, their relationship to child, best phone numbers or other contact information that will be helpful in an emergency.

List any chronic illness and or physical limitaitons we should know about: (If none, enter none)*

List any medical food allergies: (If none, enter none)*

List all current medications: (If none, enter none)*

TERMS OF AGREEMENT

PHOTO RELEASE:

I hereby give permission for my child to be photographed during the CNL Studios Foundation, Inc. Program. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that children's photos and quotes may be used for publicity purposes. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of CNL Studios Foundation, Inc. and its affiliates.
MEDICAL RELEASE:

I authorize the CNL Studios Foundation, Inc. as agent for the undersigned to consent with respect to said minor, to an x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to rendered under general or special supervision of, any physician or surgeon licensed in Florida and on the medical staff of any hospital, whether such diagnosis or treatment is rendered at the office of the physician or at the hospital. I understand that the CNL Studios Foundation, Inc. is not responsible for costs incurred for medical care. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician). In the event of any medical emergency, I authorize and consent for CNL Studios Foundation, Inc. to act on behalf for medical care deemed necessary for the participant.

HOLD HARMLESS:

I, the undersigned*, hereby release discharge, indemnify, hold harmless and defend CNL Studios Foundation, Inc. , its officers, employees and servants from any and all liability (claims, demands, losses, causes of action, suits, judgments) of any kind that I or my family may have against Created - N - Love Studios Foundation, Inc. due to death, personal injury or illness, loss or damage to property, or future causes that occur during the Created - N - Love Studios Foundation, Inc. Program.

Electronic Signature: By entering my name below, I accept the above conditions and releases. (You must be 18 years old or over to sign below.)*

First NameLast Name

Signature

Relationship to registered child:*

Current Date:*

MonthDayYear

No refund will be made once the program starts. We do not prorate fees for attending only a part of the program week.

Upon completion of filling in all areas of form, click "Submit Form". You will then be taken to Stripe where you will pay a registration fee. Only one child may be registered at a time. You may click "Print Form" to print a copy of this form. Do you have questions or need help with online registration? Email Charity at info@cnlstudiosfoundation.org