Home School Field Trip Registration

Participant Information

How many children, ages 6 and up, do you plan to bring? *

Participant's Name *

First Name Last Name

Grade Level (Fall 2018) *

Age *

Participant's Name *

First Name Last Name

Grade Level (Fall 2018) *

Age *

Participant's Name *

First Name Last Name

Grade Level (Fall 2018) *

Age *

Participant's Name *

First Name Last Name

Grade Level (Fall 2018) *

Age *

The field trips are designed for learners ages 6 and up. We understand that occasionally families need to bring younger children. The field trip cost of $8 per child applies to all children ages 3 and up.

How many children ages 3-5 do you plan to bring?

Are you members of the MESS Hall? *

Yes No

Which programs?

Which Programs? Please include all attending students, ages 6 and up, in quantity.

Have you attended a program at the MESS Hall before? *

Yes No

August

September

October

November

December

January

February

April

Member

Cost of programs

discount amount

Minus membership

Membership

Coupon Code

Onsite

Total

Total Cost

USD MESSHall1819HomeschoolPrograms

Parent/Guardian Information

Name *

First Name Last Name

Main Number *

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

example@example.com

Informed Consent and Acknowledgement

In consideration of my child’s participation in programs provided by the Pensacola MESS Hall, I indemnify and hold Pensacola MESS Hall and its affiliates, employees and agents harmless from and against any and all liability for negligence or medical expenses resulting from my child’s participation in such programs or other activities. I further release Pensacola MESS Hall and its affiliates, employees and agents from any and all negligence or other claims resulting from my child’s participation. I further understand that Pensacola MESS Hall does not provide medical insurance coverage for my child and that any medical expenses incurred will be paid by either my own medical insurance or myself. I hereby grant permission for my child to participate in all activities.

I give permission for my child’s photo and/or likeness to be retained and used by Pensacola MESS Hall without any remuneration or compensation.

Cancellation Policy & Tuition Refund

If a cancellation occurs…	Amount Refunded
5 or more calendar days before a program is scheduled to start (includes the weekend)	100%
1 to 4 calendar days before a program is scheduled to start (includes the weekend)	50%
Due to a no-show on the day the program is scheduled to start or subsequent days	0%

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.

Please ensure that you indicated the number of students attending the homeschool program above. The submission button will appear when the total is greater than $0.

Home School 2018-2019 Field Trip Registration