Application and Consent Form
You are required to fill out this form before or at the time you arrive at Nine Studio. Should you have questions, please contact us at info@nine.education or 415.678.5091. Thank you for filling out this form online! We look forward to meeting your family!
Email address *
Student's Name and Grade *
Your answer
Student's Birthday *
MM
/
DD
/
YYYY
Address *
Your answer
Siblings Joining at Nine Studio?
Name of school student attends *
Your answer
Mother's/Father's/Guardian's Name *
Your answer
Phone Number *
Your answer
Preferred contact method
Emergency Contact Name and Phone number (if parent is not available)
Your answer
Name of class(es) student will register at Nine *
Your answer
What goals do you have for your child/children at Nine Studio?
Your answer
How did you hear about us? *
Your answer
Child’s Medical Information
Any health problems we should know: *
Your answer
Medication, if any:
Your answer
Allergies, if any:
Your answer
Special concerns:
Your answer
Any activities child should NOT participate in:
Your answer
I hereby grant permission for my child to participate in Nine Studio program. I agree that, to my knowledge, my child is physically and medically able to participate in these activities. If any injuries do occur to my child, I also understand that the staffs in Nine Studio will contact parents/guardians immediately. I agree to pick up my child promptly. Parents/Guardians will be required to sign out their child at pickup. Please sign your name below. *
Your answer
Trip Release form *
Required
Permission to have someone else pick up your child. I hereby give my permission for the following people to pick up my child. Please add their names below.
Your answer
Studio Policy
PAYMENT POLICY *PAYMENT AND REFUND POLICY: Unfortunately we do not offer refunds, but we are more than happy to schedule a make-up class or transfer your child to another class that is a better fit. *
Required
General policy at Nine Studio *
Required
Parents' signatures
Please type your name and date below. *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of New Intelligence Next Education, LLC. Report Abuse - Terms of Service