Home School Gym Class Registration 2022-2023
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Child's First Name *
Child's Last Name *
Gender *
Child's Birthday *
Child's Address *
Zip Code *
Which session(s) are you registering for? *
Which Quarter(s) are you registering for? *
Parent/Guardian Names *
Parent Phone number #1 *
Parent Phone number #2
Parent E-mail Address #1 *
Parent E-mail Address #2
Additional Emergency Contact Name *
Emergency Contact Phone Number *
Does child have any allergies, chronic illnesses or medical conditions? If so, please describe: *
Is your child prescribed an inhaler? If yes, please provide the prescription with the inhaler at all sessions.
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Payment Form *
Informed Consent and Acknowledgement: I hereby give my approval for my child's participation in Home School Gym at the Arctic Rec Center. In exchange for the acceptance of said child's candidacy by the Arctic Rec Center, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless, the Arctic Rec Center, and all its respective officers, agents and representatives from any and all liability for injuries to said child arising out of participating in the program. In case of injury to said child, I hereby waive all claims against the Arctic Rec Center, including coaches and affiliates, all participants, sponsoring agencies, advertisers, and if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent to all sports activities. Some of these injuries include, but are not limited to the risk of fractures, paralysis or death. ***Home School Gym includes close contact games and brings with it the risk of illness, including Covid-19. Each player understands the risk of a close contact sport during this illness season.*** By entering your initials below, you are consenting to give your approval for your child's participation in Home School Gym *
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