Registration and Release of Liability - Launching Success Robotics 1.1
Parent/Guardian Name:
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My child's name (First):
Please register each child separatey
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Last:
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Grade:
Have you taken Bricks and Beyond's 1.1 class before, and if so, where?
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My contact phone number is (### - ### - ####):
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I can receive text messages at this number (###-###-####)
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An *Alternate* emergency contact number is (###-###-####)
must be different from above
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Please list any of your child's food allergies
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To better help us team up your child, please describe how they work with others (temperment) and how they learn best (learning style).
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Pick up plan: Person 1
Please list the people authorized to pick up your child from camp
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Pick up plan: Person 2
Please list the people authorized to pick up your child from camp
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Email:
Please provide an email for updates and news about class
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Please note: It is important for you, the legal guardian, to sign your child out.
May we use your child's picture for advertising purposes? (child's name and location will not be included)
I understand by agreeing to this Brick and Beyond is not responsible for the use of these pictures by other parties
I confirm that my child is participating in one or more educational classes offered by Bricks and Beyond, LLC ("Bricks and Beyond"), with knowledge and consent of both of my child's parents/guardians
In signing this waiver, release and warning of risk, I agree and confirm as follows:
1. I fully understand that the classes will have many other participants interacting with one another. When many children participate in a class together, there is always the risk that arguments or disagreements may arise between them which may result in pushing, shoving, arguments and so forth. Class instructors will do their best to monitor behavioral issues but there may be times where such behavior may take place before an instructor has the time to intervene to stop it. In enrolling my child in any classes, I fully accept this risk.

2. The classes involve building and programming working LEGO models. LEGO models are assembled using many small plastic and in some cases metal pieces that can easily be swallowed by a child. Classes may also involve the use of small magnetic parts and marbles. Although the class instructors will warn each participant not to place small objects in their mouths and will do their best to enforce this, participation in the classes involves the inherent risk of my child swallowing LEGO or other pieces used to assemble models, which could lead to my child suffering serious injury. In enrolling my child in any classes, I fully accept this risk.

3. I fully understand that the classes will have many other participants interacting with one another. When many children participate in a class together, there is always the risk that one or more children may be ill or infected in some fashion, which may spread to the other participants. I full accept that Bricks and Beyond has no way of monitoring this risk and is not responsible if my child becomes ill or infected whilst participating in any classes.

4. My child is in good health and in proper physical condition to participate in the classes and is current in all immunizations mandated by Washington state law. I have disclosed all known health conditions that apply to my child.

5. There may be other risks and social and economic losses associated with my child’s participation in the classes that are not known to me or foreseeable at this time. I fully accept and assume all such risks and all responsibility for losses, costs, and damages I or my child may incur as a result of my child’s participation in any classes.

6. In consideration of the opportunity to have my child participate in the classes offered by Bricks and Beyond, I, for myself, my personal representatives, assigns, heirs, next of kin, and all those claiming by or through me, consent to and do hereby release, discharge, and forever hold harmless Bricks and Beyond, its members, employees, instructors who may assist Bricks and Beyond in running the classes, and any and all persons and entities whose property and/or personnel are involved in the classes or provide materials or equipment for the classes from responsibility for any injuries or harm of any nature whatsoever that I or my child may suffer, or for any damage whatsoever to my or my child’s clothing or personal property as a result, either directly or indirectly, of my child’s participation in the classes offered by Bricks and Beyond.

7. I further agree that if, despite this release and waiver, I or anyone on my behalf, makes a claim against any of these releasees, I will indemnify, save and hold harmless each release from any litigation expenses, attorney fees, loss, liability, damage or cost which any may incur as a result of such claim, to the fullest extent permitted by law.

8. Bricks and Beyond shall have the right at any time and in its sole discretion, to deny my child admission to any of the classes and to remove my child from any of the classes without having to furnish any reasons for its decision.

9. In the event of an accident, all reasonable efforts will be made to contact the parent immediately. However, if the injury or illness appears serious and the parent cannot be reached, the adult in charge will secure emergency treatment.

Date:
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Signature
By typing my name below, I certify that I am electronically signing this document in agreement of the terms set above.
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I understand that it is important to contact the instructor if my child will be absent.
Payment Method
Please check the box, and click on the link to pay for the class via Paypal. This will be the only payment method accepted. If payment is not received, you will automatically be added to the wait list. When the class is full, all further sign-ups will be added to the wait list and payment will be collected if the child is added to the class. If registering for multiple sessions or children, you must register two separate times.
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Additional Comments
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