Summer Course Registration Form 2023

Summer Course Registration Form

Complete this form and submit payment to register for Spark Success Summer Courses.
Parent's Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Parent E-mail
example@example.com
Phone Number
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Child E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Courses
Additional Comments

Liability Release - Read and Understand

THIS IS A RELEASE OF LEGAL RIGHTS — READ AND UNDERSTAND BEFORE SIGNING
I hereby certify that I am the adult parent or guardian of the minor child identified in this registration form under the age of eighteen years, and I consent to their participation in recreational activities at the the identified location of the course (Bolton Town Common, 156 Century Mill Road, Bolton; 19 Cater Street, Berlin, or other identified locations in course materials shared with families of registered students.

I understand and acknowledge that I am fully aware of and assume the risks (including but not limited to the risk ofserious bodily injury, property loss or damage) of said minor child’s participation in recreational activities including outdoor games, short walks on neighborhood streets, classroom participation, use of art and sports materials provided by Spark Success Coaching. I recognize my responsibility to ensure that said minor child participates only in those activities for which we have deemed safe.

Knowing the risks described above, I agree, personally and on behalf of the minor child named above, to assume all the risks and responsibilities surrounding my minor child’s participation in summer courses by Spark Success Coaching . To the fullest extent allowed by law, I hold harmless and agree to indemnify Spark Success Coaching, its officers, directors, faculty, staff, volunteers, employees and agents, from and against any present or future claim, cause of action, loss or liability for injury to person or property,
which said minor child may suffer or for which said minor child may be liable to any other person, related to said minor child’s participation in recreational activities with Spark Success Coaching, resulting from any cause whatsoever, and regardless of fault.

I am at least eighteen years of age and have carefully read and freely signed this Liability Waiver and Release Form (Minor Child). I understand and agree that no oral or written representations can or will alter the contents of this document. I agree that this agreement shall be governed by the laws of the Commonwealth of Massachusetts (excluding its conflict of laws principles).
Signature

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Date

MonthDayYear
Date