2024 Summer Camp Registration
Little Panda Academy 2024 Summer Camp
Address: 3585 North University Ave., Suite 100, Provo, UT84604
Contact us at 801-885-6942 or littlepandaacademyutah@gmail.com
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Food Allergies or Significant Medical Conditions: *
Student's Full Name(s) *

Waiver of Liability

 I am the parent/guardian of the above mentioned student(s) who is or will be attending the Little Panda Academy. I understand that during this Program, my child will be involved in activities including but not limited to: indoor and outdoor games, dancing, art, and numerous other physical activities, any of which may result in injury or illness. By signing this form, I agree to release Little Panda Academy, the owner/lessor and/or lessee of the facility being used, and their associates, employees, volunteers, and independent contractors from any and all liability connected with the program. I understand that in the case of an accident involving my child, the emergency contact information that I provide will be used to contact me. If I cannot be contacted, I grant persons associated with the Program or the Director of the facility/school my child attends, with the power to determine what medical treatment is reasonably necessary. In the event of an accident or medical emergency, I will be financially responsible for any medical and transportation expenses involved.

In consideration of being permitted to the Program, on behalf of myself or my family member, I hereby release the Program, its volunteers and contractors from liability for injury, loss or death to the above-mentioned participant while using any facility and its equipment now or in the future.

I have read and agree to the terms of this waiver. 

Please type your full name below as an electronic signature accepting this waiver of liability:

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Parent's Full Name *
Email *
Method of Payment *
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Event Waiver:

Please read and acknowledge acceptance of the event waiver. All participants must have a signed event waiver on file in order to participate. I hereby give my permission to Little Panda Academy to use my child's/children's photographic likeness in all forms and media for all reasonable educational and promotional purposes without any compensation to my child or myself. This includes, but is not limited to, digital and print materials, social media, and the Little Panda Academy website. This authorization will remain in effect until revocation is received in writing. Revocations must be accompanied by a photo of the subject. I have read and agree to the terms of this waiver. 

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Which Sessions below will your student attend? *
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Phone Number *
If you have any further questions or need more information please contact us by email at  littlepandaacademyutah@gmail.com or by text/call to 801-885-6942.
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