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Valentine's Day PNO: What better way to get a date night on Valentine's Day!

Send your kiddos to ABK for their own night of fun!

Price: $50 Members
$60 Non-Members

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency or Non-Billing Contact

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Gender: *	Birth Date: * (format=mm/dd/yyyy)
	School:	Grade Level:
	Allergies (Leave blank if NONE):
	Medical:
	Health Insurance / Doctor:
	:
	:
	:

Additional Information:

Event Release Form

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Release of Liability. I understand that strict observation by me, of the rules and regulations of America’s Best Kids, Inc, Athletic Edge, America’s Best Karate of South Medford, LLC, as well as all affiliates of America’s Best Kids, Inc including the use of protective equipment, will largely eliminate the possibility of accident or injury, and I hereby represent that I am physically fit to take the prescribed course of instruction and that I have had an opportunity to observe and/or participate in lessons prior to the signing of this agreement. I have chosen and voluntarily agree to use the facilities, equipment and resources provided by America’s Best Kids at my own risk with knowledge of the risks involved. I further understand and agree that I release from liability and waive any and all claims or actions for personal injury or death or property damage or loss against America’s Best Kids, its owners, officers, operators, employees and affiliated persons, whether caused by the fault, negligence, omission, or any other act however caused, of America’s Best Kids, Inc, America’s Best Karate of South Medford, LLC, as well as all affiliates of America’s Best Kids, Inc .
Medical Authorization: I hereby authorize the staff of America’s Best Kids, Inc, Athletic Edge, America’s Best Karate of South Medford, LLC, as well as all affiliates of America’s Best Kids, Inc to act for me according to their judgment in any emergency requiring medical attention, and hereby waive and release the school and its staff from any and all liability for injuries or illness incurred while in the school. I have no knowledge of any physical impairment that may affect the above named student participation in the program and have read and understand the terms and conditions outlined in the accompanying material including the membership agreement.

Photo Release. I do hereby give America's Best Kids the irrevocable right to use picture or photograph in all forms for display or advertising or any other lawful purposes.

Pool Activities and Swimming Release. All children age 5 and under; or non-swimmable child of any age; is required to have a parent or legal guardian in the pool or on the pool deck at all times during their child's activity in the pool. All swimmers are required to shower before entering the pool. I hereby give America's Best Kids Sport Center staff permission to take my child swimming in America's Best Kids swimming pool. It is my understanding that at all times my child will remain on site and be supervised by an America's Best Kids Sports Center Certified lifeguard. During the time which my child/children are swimming with camp, he/she is under the rules and regulations set forth by America's Best Kid's Sports Center and will also be supervised by America's Best Kids Child Care Staff. Children under 6yrs of age must have parent or guardian on the pool deck at all times.

I've read the above and agree.

Event Registration and Payment Policy

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Payments

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