Enrichment Registration Form

Student Name *

First NameLast Name

Age *

Gender *

Parents Name*

First NameLast Name

E-mail*

Phone Number:*

Area CodePhone Number

Name/Phone Number of Emergency Contact *

Name of the Enrichment Class and Name of the School *

Registration Fee *

USD

WAIVER OF LIABILITY

Liability Disclaimer & Notices: please read carefully.

I individually and as parent and/or guardian of the minor child identified above hereby acknowledge the following notices and grant to Your Sunshine the following release from liability:

A. I understand that any enrichment class includes physical movement and activites. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. I acknowledge and fully understand that I, or my child, will be engaging in physical activities that may involve some risk of injury. I acknowledge and have been advised that it is my responsibility to consult with my or my child’s physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect my or my child’s participation. I assume the foregoing risks and accept full personal responsibility for any personal injuries sustained by my child which might incur as a result or participating in this program and discharge and hold harmless Your Sunshine, its owners, directors, members, employees and agents from any claim, cause of action or liability for damages arising from any personal injury to my child or other persons or property caused by myself or my child’s participation in the Your Sunshine Enrichment program.
B. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Your Sunshine and their instructors. If you have a medical condition that may affect your ability to safely participate please consult your physician before engaging in any activities.
C. I clearly understand that cancellations are to be made before the second attended class in order to receive a prorated refund. I agree and understand that there is a $40 processing fee for all refunds and that I will not receive any refund or credit for attended classes.

USE OF PHOTOS

Your Sunshine includes photos of Your Sunshine activities on its website, educational materials, publications, & advertisements. Photos sometimes include classes of students engaged in enrichment programs. In such materials Your Sunshine will not identify any individual student by name unless specifically and separately authorized by guardians or parents. By signing this release form you are hereby granting permission to Your Sunshine, its representatives and employees the right to take photographs of classes that may include your child and authorize Your Sunshine, its assigns and transferees to copyright, use and publish the same in print and/or electronically for any lawful purpose, including such purposes as publicity, illustration, advertising, & web content.

Signature

By clicking the "Pay Now" button you are submiting your online application and will be re-directed to Paypal to submit your payment. Once we recieve your payment, we will contact you about your Membership.

Thank you!

www.yoursunshine.org

Registration & Waiver Form