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Fee per Student:
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Room:
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Family Information |
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Students entered below will be added to your family's account
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Add New Student #1:
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Add New Student #2:
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Add New Student #3:
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Add New Student #4:
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Add New Student #5:
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Additional Information: |
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Release of Liability
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As the legal parent or guardian, I release and hold harmless Freckled Frog Learning Center its owners and operators from any and all liability, claims, demands, and causes of action whats so ever, arising out of or relating to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control of Freckled Frog Learning Center, its owners and operators or in route to or from any said premises. I/we accept that, correct teaching may involve the use of touch by the Freckled Frog faculty members as a necessary tool to correct placement, lines and positions and by signing below I/we authorize and agree to these teaching practices.
I've read the above and agree.
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Consent of Photography/Video
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In signing this form, I consent to and authorize the use and reproduction by Freckled Frog, of any and all photographs, recordings, videotapes, and/or other reproductions of likeness of the student's person or characteristics without compensation to the student.
I've read the above and agree.
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No Refunds
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In signing this form, I consent to and authorize my credit card to be charged $5 for the online class. I understand that there is no refunds for this charge for any reason. I understand that if I am unable to participate in this online class that I will be able to request a make up class by emailing my request to info@freckledfrog.com.
I've read the above and agree.
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Other Questions/Comments: |
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Credit Card Verification: |
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Card Number: * |
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Name as it appears on card: * |
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Nickname:
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Card Expiration Month: * |
Exp Year: *
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Address Line 1:
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Address Line 2:
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City:
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State:
Zip:*
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