KAVI Kings and Queens
Start Date: October 12, 2017
Location: Wingate HS Campus & Eagle Academy
Contact us at 347.977.5268
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Student First Name
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Student Last Name
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Student Date of Birth
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Student Street Address
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City
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State
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Zip Code
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Current School
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Parent First Name
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Parent Last Name
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Parent Phone Number (Primary)
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Parent Phone Number (Work, Secondary)
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Emergency Contact
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Emergency Contact
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I hereby consent to my child attending KAVI Kings/Queens School Program on the agreed dates. I also grant permission for my child to participate in off property trips when included as part of their described program using such means of transportation as deemed necessary by KAVI. I understand that this program may include active games, outdoor pursuits, and/or aquatic activities, as well as activities specific to chosen programs.
Required
KAVI Kings/Queens School Program requires special consideration regarding student behavior and attitude. I understand that my child must follow the direction of the leaders and adhere to the program policies regarding appropriate social behavior. Any behavior that puts the safety of others at risk cannot be tolerated. If in the opinion of the program staff, my child demonstrated persistent inappropriate behavior, (s)he will be withdrawn from the program.
I hereby consent to the taking of photographs, movies, video or audio tapes of my child by KAVI Kings/Queens School Program or its designated representatives, in connection with fundraising material, promotional brochures or videos. I also grant the right to edit, use and reuse said products for any and all educational, public service or not-for-profit purposes selected by KAVI and release any and all rights, title and interest we or my child may have in said photographs, movies/videotapes, audiotapes, finished pictures, reproductions, copies or negatives of the same in connection with such uses. (Photocopies and facsimiles of this release and consent shall have the same legal effects as the original.)
I, the undersigned parent/guardian, release KAVI Kings/Queens School Program and associated programs from all obligations in the event of an accident for which they are not negligent.
Required
I hereby give permission for the transportation of my child for official KAVI Kings/Queens School Program activities by modes of transportation agreed to by the program organizers.
Dietary restrictions
Parent/Guardian Signature (Participant Signature if at least 18 years old)
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Date
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