BSG Academy Student Registration
Please fill in student's information. Information is encrypted and protected. It is only used for BSG Academy enrollment and course communication purpose.
Email address *
Junior Coding Class *
Please Select class - please use Other to suggest Your Preferred Class Time
Student's Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's School *
Your answer
Student's School Grade *
Your answer
Parent/Guardian Name(s) *
Your answer
Home/Mailing Address *
Your answer
Phone Number(s) *
Your answer
Other Contact Info (e.g. WeChat)
Your answer
Emergency Contact Person 1 *
Please provide at least one emergency contact person name and cell phone number
Your answer
Emergency Contact Person 2
It is optional, however, we strongly encourage you provide 2nd emergency contact person name and cell phone number.
Your answer
Medical Problems/Allergies *
Please fill in N/A if no medical problem or allergy
Your answer
EMERGENCY MEDICAL RELEASE *
If emergency medical care is necessary and I cannot be reached, I authorize the Boston Software Group Inc. (BSG) to act in my behalf in granting permission for my child to receive emergency medical treatment. Parents are responsible for all expenses incurred as the result of medical treatment.
Required
HOLD HARMLESS RELEASE *
I hereby waive, release, absolve, indemnify, and agree to hold harmless the Boston Software Group, Inc., its directors, officers, organizers, sponsors, supervisory staff, participants, and any other affiliates; for, from, and against all liability because of any bodily injury, or property damage, known or unknown, which may occur or result from the participation of the above named child in any and all activities whether the result of negligence or for any other cause of the Boston Software Group. I individually, and as a parent/guardian for my child, have read this release and understood all the terms. I execute it voluntarily and with full knowledge of its significance.
Required
AUTHORIZATION TO PRODUCE AND USE AUDIOVISUAL MATERIALS
I hereby voluntary and without compensation authorize Boston Software Group, Inc. to produce photographs, movies, videotapes, audio-tapes, and Powerpoint Presentations of the below named student. This authorization is given on the condition that the materials taken or produced will be used for the purpose of community education or program promotion. I understand Boston Software Group, Inc. and its employees will not use these materials for compensation.I understand that this grant of permission shall only be revoked by a written instrument delivered to the Executive Director of the Boston Software Group, Inc. This consent shall remain in effect, unless revoked.
Coupon Code
If you have a coupon code, please provide below to be qualified for fee discount. If you are referred by a friend, please provide qualified information (for example, your friend's wechat ID) below to be eligible for discount.
Your answer
A copy of your responses will be emailed to the address you provided.
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