2024 Tunez 4 Totz

Parents Information
Mother's Name*

Mom's First NameMom's Last Name
Mother's Email*
Mother's Cell*

Area CodePhone Number
Mother's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Name

Dad's First NameDad's Last Name
Father's Email
Father's Cell

Area CodePhone Number
Father's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary email for us to contact*
example@example.com
We like to tag parents in pictures on our social media! What is your Instagram handle(s)? (optional)

Liability WaiverRelease and Indemnification
I, the undersigned parent of*
hereby consent to my child's participation in Tunez 4 Totz and AISH activities. I hereby release, waive, discharge and indemnify Tunez 4 Totz and AISH , their affiliates, agents, officers, directors, supervisors, and employees from and against any and all claims for property damages, liability or personal injuries which my child may sustain. I further agree to indemnify and defend against any and all claims for property damages, liabilities, or personal injuries which a third party may sustain by reason of any act or omission of my child.

Additionally, I understand that my child or children's pictures taken while participating may be used by Tunez 4 Totz and AISH for their marketing purposes.
Signature*

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Date:*

MonthDayYear
Date

Child 1$180.00

Child 2$144.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Parents Information