Boxercise & Relax Kids With Jennifer

Name of child

First NameLast Name

Age of child

Name of 2nd child

First NameLast Name

Age of child

Name of 3rd child

Age of child

Parent/Guardian Name

First NameLast Name

Mobile Number

Email

example@example.com

Ticket Type

Does your child have any known physical disabilities or injuries that may prevent them from participating fully? If Yes, please discuss with your Relax Kids Coach

Does your child have epilepsy? Please let your Relax Kids Coach know, as breathing exercises can bring on a seizure

Does your child have asthma? Please make sure your child brings their inhaler and informs their Relax Kids Coach

Does your child have severe allergies/anaphylaxis? If your child requires an Epi-Pen, please make sure your Relax Kids Coach is fully briefed as there is an additionalform to complete

Is your child taking any medications? If Yes, please state what medication

Medication

Is your child willing to do Relax Kids?

Boxercise & Relax Kids classes is a high energy class which include punching focus pads with boxing gloves, lots of vigorous exercises, movement, stretches, visualisations, breathing exercises and children massaging each other (clothed and sitting up). Whilst we work in the safest manner your child may be hurt by another child or injured during activity. Do you consent to your child being involved in these activities? Please speak to your Coach if you have any concerns

Who is picking up the child?

If your child is 11 years old or above, do you give them permission to walk home alone?

How did you hear about Relax Kids With Jennifer?

Do you consent to your child/children being included in Social Media pictures and videos?

I individually and as a parent and or guardian of the child or children above hereby agree to the following:Parent’s responsibilities:Relax Kids takes all reasonable care to ensure that it’s programmes are fun and safe. However, I understand that my child will be engaging in a high amount of physical activity that may involve some risk of injury. I acknowledge I have been advised 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 child’s participation in the Boxercise & Relax Kids programme. In the event of emergency and in my absence agree to the Relax Kids Coach contacting the Emergency Services.I have read the Relax Kids Child Protection Policy (available on request) and in the event of my child not being collected I agree that Relax Kids can contact the social services duty officer for my child’s protection.I confirm that I have fully disclosed to Relax Kids and/or the Coach any, and all, conditions (whether such conditions are physical, behavioural or otherwise) that my child has or may have before participates in the class.As far as permitted under Local Law, I assume the above risks and accept responsibility for any injury sustained by my child. I further discharge and hold harmless Boxercise or Relax Kids (including it’s owners, officers and personnel, including it’s Coaches and it’s suppliers) from any liability: arising from any injury to my child or other persons or property caused by my child’s participation in the Boxercise & Relax Kids programme, if that injury is caused by my or my child’s fault: or by a third party unconnected with Boxercise & Relax Kids provision of services; or by events which Boxercise & Relax Kids, including it’s owners, officers and personnel, including it’s Coaches and it’s suppliers, could not have foreseen or prevented, even if they had taken reasonable care.Refund Classes: Pro-rated refunds will be given if cancellation is done, in writing, before the second attended class of the series. I understand and agree that I will not receive any refund or credit for missed classes, but if cancellation of a class is due to failure on the part of Relax Kids Coach that class I will be entitled to a reasonable refund of the charge for that class. After 2 classes it may be apparent to the Relax Kids Coach that classes are not appropriate for a child at this stage, in this instance we will request the child be removed from the class and the balance refunded. Consent and storage of information. This forms collects your name, address and email please contact me for my Privacy Policy. To view Relax Kids Privacy Policy, please visit www.relaxkids.com/privacy-policy

I consent to you using my email address for future marketing of Relax Kids With Jennifer ONLY

Signature

Date

My Products

Boxercise & Relax Kids Monday 27th April 11am Product Image

Boxercise & Relax Kids Monday 27th April 11am£2.50

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Boxercise & Relax Kids Tuesday 28th April 11am Product Image

Boxercise & Relax Kids Tuesday 28th April 11am £2.50

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Boxercise & Relax Kids Wednesday 29th April 11am Product Image

Boxercise & Relax Kids Wednesday 29th April 11am £2.50

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Boxercise & Relax Kids Thursday 30th April 11am Product Image

Boxercise & Relax Kids Thursday 30th April 11am £2.50

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Boxercise & Relax Kids Friday 1st May 11am Product Image

Boxercise & Relax Kids Friday 1st May 11am £2.50

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Boxercise & Relax Kids Friday 1st May 11am 2 Product Image

Boxercise & Relax Kids Friday 1st May 11am 2£2.50

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Boxercise & Relax Kids Weekly Pass £10.00

This pass entitles access to all five Boxercise classes from Monday 27th April to Friday 1st May.

Total £0.00

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

PRE PAYMENT CONFIRMS PLACE - unless otherwise agreed.

Payment by BACS, please use your child’s name as reference:

Relax Kids With Jennifer Ltd Sort: 09-01-29 Account: 25747384 Or PayPal jennifertaylor@relaxkids.com

Please feel to contact me by email or phone if you have any concerns; 07583935001

All schools are welcome to a free Relax Kids taster session, if you’d like your school to have one please ask.