ZalaSmart - Registration Form
Thank you for choosing ZalaSmart's Money Smart Kids & Teen program! We appreciate your business. After the registration form is complete the next section will provide you details on how to make payments. Please note that no payments are required for registering to the waiting list.
Email address *
Which ZalaSmart program are you registering a participant for? *
Please note that ages ranges are recommendations only. We have had students up to age 15 join the Money Smart Kids ages 9 to 12 program and they loved it! We will open up a session in your area once we've reached our quota. Please join our waiting list.
Participants first and last name *
Your answer
Participants date of birth *
(dd-mm-yyyy)
Your answer
In case of emergency, who should we call? *
Please state the emergency contact's first and last name, relation to participant (example: mother, father, guardian, etc.), and phone number if not listed below).
Your answer
Waiver *
ZalaSmart may take pictures of participants of its program or camp for promotional use. By checking this box you agree to the following terms.I hereby grant ZalaSmart permission to use the participant I am registererings likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.I understand and agree that all photos will become the property of ZalaSmart and will not be returned.I hereby irrevocably authorize ZalaSmart to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.I hereby hold harmless, release, and forever discharge ZalaSmart from all claims, demands, and causes of action, which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, AND HAVE RECEIVED CONSENT FROM THE PARENT(S)/GUARDIAN(S) OF PARTICIPANT REGISTERED FOR A ZALASMART EVENT.
Required
How did you find out about us? *
Your name *
First and Last
Your answer
Your phone number *
(xxx-xxx-xxxx)
Your answer
Which part of town do you live in? *
This will allow us to let you know the closest Money Smart Kids & Teens program in your area.
Questions and comments
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of ZalaSmart. Report Abuse - Terms of Service