NBC Participation Waiver & Parent Contract

Students will need parent/legal guardian's consent to be released to NBC enrichment programs and/or transportation services.

Champion's Name*

First NameLast Name

Current Grade*

Pre-K-12th Grade ONLY

School ID #*

Pre-K-12th Grade ONLY

Grade

Pre-K-12th

Champion's DOB*

Date

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

School Name or Number*

School Name*

School Phone Number*

School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

School Start Time

Hour Minutes

AM/PM Option

School End Time

Hour Minutes

AM/PM Option

Homeroom Teacher's Name*

First NameLast Name

This Champion will participate in the following NBC program(s) at their school or program site: (select all that apply)*

Please let us know if this student has any allergies, existing illnesses or any medical conditions.*

Please enter "none" if not applicable

Are they currently taking any medication? If yes, please provide the generic name and its purpose?*

Please enter "none" if not applicable

Parent/Guardian Name*

First NameLast Name

Phone Number*

Email*

example@example.com

Emergency Contact*

First NameLast Name

Phone Number*

This student has my authorization to engage in the activities of the Natural Born Champions Inc. programs.

I agree to opt-in for text updates.

I guarantee that this participant will adhere to the rules and regulations of the program.

I allow taking photography of this student that can be used for Natural Born Champions Inc. program portfolio or advertising.

I authorized Natural Born Champions Inc. to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. I allow them to apply first aid, medical or surgical diagnosis and treatment as necessary.

I allow Natural Born Champions Inc. to provide or administer the medication or supervise in self-administration.

I release Natural Born Champions Inc. and any of its coaches, staff, and manager for any responsibility in case of accident, illness, or injury during this student's enrollment.

This student is allowed to be driven in Natural Born Champions Inc. van. This includes all transportation services (e.g. before & after care, field trips, etc.)
If this participant does present symptoms or a positive covid-19 test or other illnesses, I agree to keep this participant home until for 2 business days.

I guarantee this participant will abide in all sanitary practices to control the possible spread of the corona virus such as hand washing, wearing a mask, and getting temperature taken.

I acknowledge the risk of injury due to activities and outdoor play during NBC programming.

I waive the right to sue for injuries resulting from ordinary negligence during NBC programs.

I acknowledge and agree to NBC Program Rules.

This student is allowed to share progress reports and report cards to the NBC Team for tutoring purposes.

This student's school is allowed to share dignostic data for tutoring and SEL support.

This student is allowed to attend monthly counseling with the NBC Team and a licensed therapist.

I acknowledge my role in the program.

My child can participate in program surveys for NBC data collection only.

I have read and agree to the terms and conditions of this program.

Date Signed*

Date

Parent/Guardian Signature*

Participant Authorization Form

Champion Information

Parent/Guardian Information

Authorization and Terms