Protect Your Pretty form

Protect Your Pretty

2024-2025 REGISTRATION FORM
Child's Name
Date of Birth
School Name/Grade
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT/GUARDIAN INFORMATION
Full Name

First NameLast Name
Cell Phone #

Area CodePhone Number
Alternate Phone #

Area CodePhone Number
Full Name

First NameLast Name
Cell Phone #

Area CodePhone Number
Alternate Phone #

Area CodePhone Number
EMERGENCY CONTACT INFORMATION: Other than Parent/Guardian
Full Name

First NameLast Name
Phone #

Area CodePhone Number
Relationship
Full Name

First NameLast Name
Phone #

Area CodePhone Number
Relationship
Does your child child have any problems, injuries or allergies that might affect her/him from fully participating in the activities with P.Y.P? Please describe and include additional notes to the staff here:
Registration assumes full participation for the ENTIRE school year. You may cancel enrollment by contacting program director and/or The Brilliance School.

There will be field trips throughout the school year and registration fees will be adjusted accordingly to accommodate students.

I hereby grant permission for my child to attend and participate in The Protect Your Pretty program listed herein & agree to the Terms and Conditions set forth herein. I hereby release and discharge P.Y.P and its employees, and contractors from and against all claims and losses of any type arising out of or relating to my child's participation in classes at The Brilliance School.

I am 18 years of age or older and the parent or legal guardian of the above-named child.
By checking this box, you agree to have read the terms and conditions of our policy*

I agreeI do not agree
Should be Empty: