LP ASEP Waiver & Release (Winter/ Spring 2019)
IMPORTANT NOTES:

- This form is **STEP 2** of the Registration Process for LP Fall ASEP classes. Please complete one form/ student.

- In addition to this Waiver and Release form, **STEP 1** was to SIGN-UP WITH THE VENDOR of each class & pay them directly to be officially enrolled in the class.

- More info about the LP Winter ASEP Classes: https://docs.google.com/document/d/1DmExyL2sWgYq418YIr75SpHRJ9Pl2uqmY6MrbQa4UII/edit?usp=sharing

- If your student attends Panther Club be sure to update Panther with new Release Info: https://goo.gl/forms/4BUKrgPE5dJDi1h73

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

Student Name (First & Last) *
Your answer
Teacher's Name *
Required
Early/ Late/ 3rd-5th *
MONDAY ASEP CLASS
You MUST complete Questions 1, 2 and 3 ONLY IF your student is enrolled in a Monday class, otherwise skip this section.
1- Choose Monday ASEP Class (then answer questions 2 & 3):
2- (Before Monday ASEP class) Arriving from:
3- (After Monday ASEP class) - Release to:
TUESDAY ASEP CLASS
You MUST complete Questions 4, 5 and 6 ONLY IF your student is enrolled in a Tuesday class, otherwise skip this section.
4- Choose Tuesday ASEP Class (then answer questions 5 & 6):
5- (Before Tuesday ASEP class) Arriving from:
6- (After Tuesday ASEP class) - Release to:
WEDNESDAY ASEP CLASS
You MUST complete Questions 7, 8, and 9 ONLY IF your student is enrolled in a Wednesday class, otherwise skip this section.
7- Choose Wednesday ASEP Class (then answer questions 8 & 9):
8- (Before Wednesday ASEP class) Arriving from:
9- (After Wednesday ASEP class) - Release to:
THURSDAY ASEP CLASS
You MUST complete Questions 10, 11 and 12 ONLY IF your student is enrolled in a NEW Thursday class, otherwise skip this section. (Skip this section if your student is currently in LTA- Peter Pan.)
10- Choose Thurs ASEP Class (then answer questions 11 & 12)
11- (Before Thursday ASEP class) Arriving from:
12- (After Thursday ASEP class) - Release to:
FRIDAY ASEP CLASS
You MUST complete Questions 13, 14 and 15 ONLY IF your student is enrolled in a Friday class, otherwise skip this section.
13- Choose Friday ASEP Class (then answer questions 14 & 15):
14- (Before Friday ASEP class) Arriving from:
15- (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 (besides Parent listed above) *
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. (NOTE: if student is enrolled in Panther or is in TK/K, Vendor or ASEP Parent Volunteer will take student to class) *
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- URL for Panther Release Form is here: https://goo.gl/forms/4BUKrgPE5dJDi1h73. *
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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