2018-2019 Cheval Kids Registration
Please Choose How Many Kids You Would Like to Register
Child (ren)
1
2
3
Child 1 Name *
Your answer
Child 1 Birthday *
MM
/
DD
/
YYYY
Child 1 Grade
Child 1 School *
Child 2 Name
Your answer
Child 2 Birthday
MM
/
DD
/
YYYY
Child 2 Grade
Child 2 School
Child 3 Name
Your answer
Child 3 Birthday
MM
/
DD
/
YYYY
Child 3 Grade
Child 3 School
Home Address *
Your answer
Parent/Guardian Main Contact *
Your answer
Email *
Your answer
Cell Phone *
Your answer
Alternate Phone *
Your answer
Parent/Guardian Secondary Contact *
Your answer
Email *
Your answer
Cell Phone *
Your answer
Alternate Phone *
Your answer
Local Emergency Contact (other than parent/guardian) *
Your answer
Relation to Child *
Your answer
Cell Phone *
Your answer
Photo & Video: *
I grant full permission to the Cheval Golf & Athletic Club to use photographs and video tape of my child(ren) for publication for Cheval Golf & Athletic Club publicity purposes.
Transportation Release: *
I give my child/children permission to be transported by the Cheval Golf & Athletic Club. I understand that the Cheval Golf & Athletic Club will provide transportation on scheduled field trips and to and from school each day.
Cheval Release Waiver *
Captionless Image
Emergency Medical Treatment Agreement: *
I/We understand that if my child should become ill or injured at Cheval All Stars, that Cheval will (1) contact me immediately and (2) contact the person(s) I have designated if I cannot be reached. Should Cheval be unable to reach me and/or the person(s) designated, Cheval is authorized to contact my child’s physician and/or arrange for immediate medical treatment. The physician and/or medical facility are authorized to administer emergency medical treatment necessary to ensure the health and safety of my child. I/We will accept responsibility for payment of medical services rendered.
Preferred Physician *
Your answer
Physician Phone # *
Your answer
Preferred Hospital *
Your answer
Insurance Company Name *
Your answer
Group Insurance Policy Number *
Your answer
Allergy Information *
My child has allergies
Allergies & How to Care for Your Child
Your answer
Registration Fee
There is a $30 registration fee due at the time of registering for the Cheval Kids program. Please understand, we need to receive payment for the registration to be valid.Once payment is received, no refunds will be issued.
Financial Agreement *
Their registration fee due at the time of registration is nonrefundable and nontransferable. I understand that all fees will automatically be billed to my account on the 10th of each month (August 2017-May 2018) with a 3% surcharge added. To avoid the 3% surcharge, checks are accepted through the 8th of each month. My account will be charged an additional $25 for any NSF charges that may occur. The Cheval Kids Membership is a monthly membership and therefore it will not be prorated for non school days. No credits or refunds will be issued for absence. I understand that I will be charged $1 per minute per child after 6:30 pm. Should I wish to cancel the Cheval Kids Membership, I must notify the Director of Youth Development, in writing, at least 30 days prior to cancellation. Due to the nature of this program, there is a cancellation fee, per child, of $65.00.
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