Registration
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For students who complete the Franklin-Springboro Library Summer Reading Program!
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Adult Student
Father
Grandparent
Guardian
Mother
Parent
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female / SHE
Male / HE
Other / THEY
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female / SHE
Male / HE
Other / THEY
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female / SHE
Male / HE
Other / THEY
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female / SHE
Male / HE
Other / THEY
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female / SHE
Male / HE
Other / THEY
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Questions/Options:
Additional Information:
Consent to Participate
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As the adult student or Parent or Legal Guardian of the minor student(s) named above, I consent to their participation in the programs offered by ADAD Trifiro Limited, LLC DBA Ohio Sports Academy, Dragonfly Aerial Arts, or Ninja Zone and to use facilities at Ohio Sports Academy owned by DADA Limited LLC. I understand the nature the nature of the activities and believe myself or my minor child/children to be qualified, in good health, and in proper physical condition to participate in such activities.
I've read the above and agree.
Release of Liability
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In consideration for my(if over 18) or my child(ren's) participation, I (we) hereby for myself and my child(ren) and our respective heirs, executors and administrators, COVENANT NOT TO SUE and FOREVER RELEASE ADAD Trifiro Limited, LLC (Ohio Sports Academy) DADA Limited, LLC (the landlord) and the Ninja Zone, and or Dragonfly Aerial Company, the owners, operators, directors, officers, employees and other members of the "releases" named above, from personal injury or accident of any sort or nature suffered by me (us), the undersigned, by reason of participation or membership in classes, lessons or any programs or activities of Ohio Sports Academy(ADAD Trifiro Limited LLC) Dragon Fly Aerial Arts or the Ninja Zone including those resulting from acts of negligence. I also assume all medical expenses for the aforementioned child or myself, which may be the result of any injuries sustained while training at, or performing for Ohio Sports Academy (ADAD Trifiro Limited LLC). Further, it is affirmed that sufficient insurance covering all such injuries and damages shall be in full force and effect throughout the program or its equivalent throughout the child's/parent's gymnastics career by my insurance.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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