LP ASEP Waiver & Release (Spring 2017)
This is STEP 2 of the Registration Process for LP Spring ASEP classes. Please complete one form/ student.

In addition to this Waiver and Release form, you MUST sign up with the Vendor of each class & pay them directly to be officially enrolled in the class.

If you would like more info about the LP Spring ASEP Classes, please see our WebPage- http://lp.moraga.k12.ca.us/ASEP

Any questions, please email your ASEP Coordinators: Aude Gaudio and Kelli Bacher at losperalesasep@gmail.com.

Student Name (First & Last)
Your answer
Teacher's Name
Early/ Late/ 3rd-5th
Choose Monday ASEP class:
(Before Monday ASEP class) Arriving from:
(After Monday ASEP class) - Release to:
Choose Tuesday ASEP Class
(Before Tuesday ASEP class) Arriving from:
(After Tuesday ASEP class) - Release to:
Choose Wednesday ASEP Class
(Before Wednesday ASEP class) Arriving from:
(After Wednesday ASEP class) - Release to:
If your student is in a Thursday ASEP class, the PTA and Vendors already have this info.
Choose Friday ASEP Class
(Before Friday ASEP class) Arriving from:
(After Friday ASEP class) - Release to:
Important Info and Waiver
Primary Parent First & Last Name
Your answer
Phone Number To Be Reached DURING Class
Your answer
Primary Email Address
Your answer
I (we) hereby advise that the above named minor has had the following allergies, medicine reactions or unusual physical condition which should be made known to a treating physician or which could limit participation: (if none, write NONE).
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone
Your answer
Additional Adults Authorized to Pick Up From Any ASEP Class
Your answer
Physician Name
Your answer
Physician Phone
Your answer
It is parent/student responsibility to get to class unless enrolled in Panther. (*Note: The ASEP instructor/ ASEP volunteer is responsible for escorting the late bird TK/K students from the school dismissal area.)
I understand that if I am 10 or more minutes late picking up my child, he/she may be escorted to the Panther Club, and I will be responsible for reimbursing Panther Club.
I understand that if my child attends Panther, a release form must be on file with Panther.
If my child will miss an ASEP class, I will contact the vendor directly to alert them.
I understand that class registration and payment must be made directly to the vendor.
I have read and understand the above ASEP Waiver (please type full name as your signature)
Your answer
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