Educational Experience Registration!

Gender

Grade (You will be entering) *

Student Name*

First NameMiddle NameLast Name

Parent Email - Primary Communication Channel*

Parent Email - Secondary Communication Channel

example@example.com

Phone Number - Primary *

Area CodePhone Number

Phone Number - Secondary

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County of Residence *

Ex: Marion County

Emergency Contact Information and Insurance

Name (Emergency Contact)*

First NameLast Name

Phone Number (Emergency Contact)*

Area CodePhone Number

Email (Emergency Contact)*

example@example.com

Relationship

Dietary Needs*

Insurance Company *

My Products

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

MEDIA RELEASE & WAIVER OF LIABILITY

In consideration for participating in any way at the NAYR Foundation Inc., DBA Indiana Aviation Career Education (ACE) Academy, I the undersigned acknowledge and agree that:

1. The NAYR Foundation Inc., DBA Indianapolis Ace Academy LLC has permission to take and use photographs and/or digital images of my child for use in media releases and educational materials. This includes printed and electronic publications, web sites, and other forms of communication. I further agree that my child’s name and identity may be used in descriptive text and commentary in connection with said image(s). All negatives, prints, and/or digital reproductions shall be the property of the NAYR Foundation Inc., DBA Indianapolis Ace Academy LLC, with no contractual obligation to compensate my child in any way.

2. Some of the activities children can be exposed in the Indianapolis ACE Academy can result in physical or emotional stress, injury, paralysis, disability, death or property damage. Risks can arise from the nature of some of the activities, to include: negligence on the part of my child, the program instructors, or the omissions of third party individuals facilitating my child’s participation in a particular activity. For my child, I willingly assume all risks, both known and unknown, even if arising from negligence of the NAYR Foundation Inc., DBA Indianapolis Ace Academy LLC or others associated with the program, and assume full responsibility for my child’s participation.

3. I agree to abide by the rules of the NAYR Foundation Inc., DBA Indianapolis Ace Academy LLC and the third party individuals or organizations providing instruction in the program. I affirm that my child will not be under the influence of alcohol or controlled substances, and will not carry, use, or consume these substances before or during scheduled ACE Academy hours.

I have read this entire document, understand its contents, and agree to be bound by its provisions.

Electronic Signature Below:

Signature*

By hitting the register button, I hereby make this application to register my son/daughter/ward in the NAYR Foundation Inc dba Indiana ACE Academy, subject to terms and conditions set forth in the current brochure/newsletter; and hereinafter mentioned; and subject to the rules and regulations of the NAYR Foundation Inc dba Indiana ACE Academy. Once submitting the application, it is understood and agreed that this application constitutes the sole agreement between the NAYR Foundation Inc dba Indiana ACE Academy and the undersigned, and there are no conditions or provisions other than herein noted.

NAYR Foundation Program Registration