Growing Healthy Now: Registration

Growing Healthy Now: Registration Form

Growing Healthy Now
467 Donofrio Drive
Downingtown, PA 19335
Registration Form

Mother’s Last Name:

First Name:

Mothers Occupation:

Fathers Last Name:

First Name:

Fathers Occupation:

Childs Last Name:

First Name:

Childs Birthday:

Gender:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

Emergency Contact:

Phone:

Family Doctor:

Phone:

Medical Insurer:

Group Number:

Name of Insured:

Policy Number:

Class Information (Check One):

Weight Control	Sports Performance Training	Come Over and Play
Session 1 4:45PM-5:45PM	Session 1 4:45PM – 5:45PM	Session 1 9:00AM – 10AM
Session 2 6:00PM-7:00PM	Session 2 6:00PM – 7:00PM	Session 2 10:00AM – 11AM
Session 3 7:15PM-8:15PM	Session 3 7:15PM – 8:15PM	Session 3 11:00 AM – 12PM

***If you don’t see a time that works for you call and we may be able to add more classes.***

Fees:

$250.00 Weight Control & $200.00 Sports Performance Training and Come Over and Play one makeup per session and no refunds. Make check payable to Growing Healthy.

Acknowledgement and Release from Liability
Please read carefully and then sign and date

In consideration of being allowed to participate in Personal Training activities sponsored by My Kid’s Trainer, and in any related events and activities, and intending to be legally bound, the undersigned states as follows:

I acknowledge that the activities of My Kid’s Trainer have inherent risks and hazards of injury, and I hereby knowingly and voluntarily assume all risks and hazards of injury incident to my child participation in all activities.
I certify that my child registered above is in excellent health and may participate in strenuous activities and that there are no limitations on his/her participation except as specifically stated on this registration form.
I acknowledge that it is my responsibility to maintain medical insurance coverage for my child, and I grant permission to My Kid’s Trainer for my child to receive emergency medical treatment if needed.
I hereby waive, release, discharge and agree to indemnify and hold harmless My Kid’s Trainer and it’s officers, directors, organizers, supervisors, volunteers, employees, participants and persons transporting participants to and from activities, from any and all claims of liability of any kind for injury sustained by my child as a result of participation in My Kids’ Trainer activities, including claiming for injury caused or alleged to be caused in whole or part by negligence of My Kid’s Trainer or any of the persons herby released.

I HAVE READ THE ABOVE WAIVER AND RELEASE, I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANITAL RIGHTS BY SIGNING IT, AND I SIGN IT VOLUNTARILY.

Parent/Guardian Signature:

Today's Date: