Strive Academy
Email address *
Parental Consent
Last Name of Child *
Your answer
First Name of Child *
Your answer
Parent(s) Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Any important information that we should know about your child (medical conditions, food allergies, etc.)
Important Information
Your answer
Other adults authorized to pick you your child
Your answer
I give permission for my child to participate in activities at Strive Academy. Should my child require immediate or emergency medical care while engaged at Strive Academy, in my absence, I grant Strive Academy the authority to release my child for medical treatment deemed appropriate under the circumstances. I understand that Strive Academy is not responsible for any injury, illness, or damage to my child/children.
*
Video/Photography Release
May Strive Academy use your child's photo/video for publications, social media sites, or newsletters?
*
Liability Release
In consideration of my child's participation in Strive Academy, I do hereby release, acquit, discharge, and agree to indemnify and defend and hold harmless Strive Academy. This includes all employees and their heirs, executors, administrations, and assigns, from any and all actions, claims, and demands of any type which my child may have or which my hereafter, occur to my child out of or connected with his/her participation in the program at Strive Academy.
*
Electronic Signature (please type your full name) *
Your answer
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