Language
English (US)
Spanish (Latin America)
2024-2025 Arc ELOP Days Enrollment
BRAWLEY ELEMENTARY SCHOOL DISTRICT
Para español
Cambia el idioma en la parte superior derecha del formulario.
I am enrolling my child in:
Dec 7
Need transportation:
Yes
No
STUDENT INFORMATION
Student Name
*
First Name
Last Name
District
School
*
Please Select
Myron D Witter
Miguel Hidalgo
Phil D Swing
JW Oakley
Barbara Worth Junior High
Padilla-Pace Middle School
Student ID#
*
Grade
*
Please Select
TK
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Age
*
Please Select
4
5
6
7
8
9
10
11
12
13
14
Birthdate
*
Street Address
*
City
*
State
*
Zip Code
*
Medical Needs/Allergies
If none, leave blank.
Other Needs (Including Emotional/Learning Needs)
If none, leave blank.
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PARENT/GUARDIAN INFO
Parent/Guardian 1
Full Name of Parent/Guardian
*
Email Address
*
Phone (Cell)
*
Please enter a valid phone number.
Phone (Other)
Please enter a valid phone number.
Accept Texts
*
Yes
No
Parent/Guardian 2
Full Name of Parent/Guardian
Email Address
Phone (Cell)
Please enter a valid phone number.
Phone (Other)
Please enter a valid phone number.
Accept Texts
Yes
No
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EMERGENCY CONTACTS
Emergency Contact 1
Name
*
Relationship
*
Phone (Cell)
*
Please enter a valid phone number.
Phone (Other)
Please enter a valid phone number.
Emergency Contact 2
Name
Relationship
Phone (Cell)
Please enter a valid phone number.
Phone (Other)
Please enter a valid phone number.
Any person to whom the student MAY NOT be legally released?
Court order must be on file.
Name
Relationship
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Release of Liability and Assumption of Risk
DUTY OF PARTICIPANTS: Some activities conducted by Good Sports Plus Ltd. doing business as arc (hereinafter, “arc”) may be hazardous to participants. All participants have a duty to act as a reasonably prudent person when engaging in the activities offered by arc. ACKNOWLEDGMENT AND ACCEPTANCE OF RISK: I understand and acknowledge that the activities which I am about to voluntarily engage bear certain known risks and unanticipated risks which could result in injury, death, illness or disease, physical or mental, or damage to myself, to my property, or to spectators or other third-parties. I accept and assume all responsibility and risk for injury, death, illness, or disease, or damage to myself or to my property. My participation in this activity is purely voluntary; no one is forcing me to participate, and I elect to participate in spite of all known and unknown risks. RELEASE: In consideration of the services and/or property provided, I, for myself and any minor children for which I am the parent, legal guardian, or otherwise responsible, any heirs, personal representatives, or assigns, do hereby release arc, its principals, directors, officers, agents, employees, and volunteers from any and all liability and waive any cause of action or complaint for any damage whatsoever arising from any cause whatsoever (except that which is gross negligence). I further agree to reimburse arc for all attorney’s fees and costs should I bring legal action against arc and lose. FILM & PHOTOGRAPHY: All photos or film taken in connection with the arc program are the sole and exclusive property of arc and may be used in any promotional materials. BEHAVIOR: arc reserves the right to dismiss participants whose behavior proves disruptive to other participants. In such cases a consultation will be held with all relevant parties before any action is taken. No refunds will be offered in such cases. ENTIRE AGREEMENT: I understand that this is the entire Agreement between myself and arc, its agents or employees, and that it cannot be modified or changed in any way by the representatives or statements of any employees of arc or by me.
Signer's Name
*
Signature
*
Date
*
-
Month
-
Day
Year
Date
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