Rabbi Fitness ™ Level Up Teen Program Spring 2021
Email *
Child's First Name *
Child's Last Name: *
Address: *
Mother's Phone Number: *
Father's Phone Number: *
Emergency Contact Name: *
Emergency Contact Phone Number: *
Specify any of your child’s health problems: *
Is your child on any medication? *
How did you hear about us?
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Is this your sons first time attending Rabbi Fitness? *
What school does your son attend? *
Grade *
Rabbi Fitness Waiver Form
I hereby state that my son is in proper mental and physical health condition to participate in the activities provided by Rabbi Fitness LLC. I am fully aware that any physical activity involving movement, force and velocity creates the possibility of serious injury. I hereby release and hold blameless Rabbi Fitness LLC, its employees and staff from liability arising from injury or damage to the person/ property of the above named student occurring in the premises being utilized by Rabbi Fitness LLC. I understand that Rabbi Fitness LLC, has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I also understand that in the event that my son engages in conduct deemed inappropriate by the instructors Rabbi Fitness LLC has the right suspend/ expel any student for such conduct. In addition, I give full permission to use any pictures or videos of my son taken during class time for advertising and promotional purposes. I further understand and accept that any classes missed due to absence(s) of my son[e.g. illness, other conflicting engagement] is NOT entitled to a refund or make up class. I further attest that all the information contained in this application is correct to the best of my knowledge.
*
You MUST pay before submitting this form. https://secure.cardknox.com/shaareizionohelbrachainst Select Activity Fee $279 Paid by Feb 25 ($400 after Feb 25) *
Child's Name: *
Parent Signature: *
Date: *
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