Class Registration Signup Form REVISED

TO THE DIRECTOR- In case you are unable to reach me during an emergency, you are authorized to contact and, if necessary, release my child to any of the following:

Contact 1: (Required)

Emergency Contact 1 Name:*

First NameLast Name

Emergency Contact 1 Cell:*

Area CodePhone Number

Emergency Contact 1 Relationship*

Contact 2: (optional)

Emergency Contact 2 Name:

First NameLast Name

Emergency Contact 2 Cell:

Area CodePhone Number

Emergency Contact 2 Relationship

Terms and Conditions:

There are no pro-ration or refunds for missed classes. A thirty (30) day notice is required if a parent
chooses to remove their child from the school. A student is entitled to one trial session with no obligation
and at no cost. If the student decides to continue, tuition will be collected from the ﬁrst class attended
(including the trial session). . If a student enrolled in the yearly program and want to cancel before
starting the yearly program, there will be a $180 canceling fee. There are no refunds once the program
started.
Children who have conflicts or problems with others during the program will be encouraged to verbalize
their feelings and concerns. The program team will assist with positive problem solving. Children are
expected to behave in respectful and responsibility way. We expected parents to be involved and help the
team to prevent and to solve any issues that may come up with their child. We reserve ourselves the right
to refuse or to dismissal of any child from the program due to disciplined, disrespected or any other
unsolved issues with no credit back.
All concern about your child may take directly to the Program Director. Parents and children are expecting
to act in respectful way to Ami School team. All students must purchase the yearly program package in
advance.
We keep ourselves the right to do any changes in and/or during the yearly program
I/We, the undersigned PARENT/GUARDIAN of the STUDENT named below hereby give full consent and
permission for the Student to participate in all activities offered by the Ami School at. The PARENTS agree to defend, indemnify, and hold harmless Ami School and their representatives, agents, assigns,
affiliates or subsidiaries, employees, attorneys, insurers, and members of the Board of Trustees (both
past and present) for any and all claims, actions, causes of action, judgments, liens, indebtedness,
damages, obligations, losses, liabilities, costs, claims for attorneys’ fees or costs, and all other claims and
rights of action of all kinds and descriptions suffered, or alleged to have been suffered, by a student,
potential student, the family members of the student or potential student, or the legal guardians,
representatives, agents, assigns, representatives, affiliates or subsidiaries, employees, attorneys,
insurers, predecessors, or successors of the student, potential student, or the family members of the
student or potential student, resulting from or in connection with any accident or injury sustained or
alleged to have been sustained in connection with any and all activities offered, hosted, or otherwise
arranged by Ami.

Terms and Conditions authorization:*

I have read and understand the Program Policy. I agree to adhere to these policies and understand that Ami School will not be responsible for any claims, costs, losses, damages or personal injuries arising from them.

Signature*

Photograph authorization:*

I hereby authorize Ami School and give permission to use my child/ren’s likeness in a photograph in any and all of its publications, including but not limited to, outreach and marketing publications, both printed and digital.I do not authorize any use of my child/ren's photograph in any of Ami School's Publications.

Choose a Payment (Payment is per student):*

Registration fee (will be deducted from full tuition fee. Further payments to be arranged with Ami School accounting department)$180.00

Number of students

Please accept my donation to support the program:$1.00

How much would you like to donate?

Total $0.00

If you did not choose to pay full tuition above please choose your preferred payment plan:

Payment in full by Cash or check or credit card due by 9/2018.Monthly payments check or credit card up to 8 equal payments- on the the 10 of each following month. First payment is due on Sep 2019).

PLEASE NOTE:

Please make up to 10 checks payable to Ami School and in the memo portion of the check,
please write the Full name of the student
Students will not be admitted to class until all fees are submitted in full along with
completed application.
There are no proration or refunds for missed classes.

For any questions, concerns, and further information please contact us via:

Email: amischool14@gmail.com

Tel: 8184552023

Students Info:

Student 1:

Student learning

Medical Info:

Student 2:

Student learning

Medical Info:

Student 3:

Student learning

Medical Info:

Student 4:

Student learning

Medical Info:

Student 5:

Student learning

Medical Info:

Parents Info:

Parent Volunteers:

Payment and Terms