Young Wizards Magic Academy Registration

YWMA Registration Form
Participant Information
Name

First NameLast Name
Birth Date

MonthDayYear
Parent/Guardian Information
Name

First NameLast Name
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the participant have any allergies, chronic illness, or medical conditions we should be made aware of? If yes, please describe.
Photo/Video Release and Authorization

During the academy, we will take photographs and videos of the different activities and lessons. Some photographs may capture your child's participation, directly or indirectly. These photos may be published through our website, social media pages, news bulletins, and ads. With this in mind, we seek for your consent in allowing us to publish photos which may involve your child to the said platforms.

Please provide your response by selecting your choice below:
I hereby allow the reproduction and publication of my child's photograph(s) and/or videos.I do not allow the reproduction and publication of my child's photograph(s) and/or videos.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Young Wizards Magic Academy. In exchange for the acceptance of said child’s candidacy by Young Wizards Magic Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Young Wizards Magic Academy and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participating in the program.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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Payment Terms and Conditions

Full payment is due with this registration form in order to guarantee a spot in the academy. There are no prorated fees for partial attendance. Payments are made through Venmo or PayPal.

In the case of cancellation before the date of May 12, the full payment will be refunded minus a $60 cancellation penalty. There are no refunds for cancellation after the date of May 12.
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Registration Fee
$600.00

Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
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YWMA Registration Form

Participant Information