Registration

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As part of our Community Appreciation Week, Angela Floyd Schools is offering a FREE class for Brownies to earn their Dance Badge. We hope you'll join us! You as a troop can log in together or each individual Girl Scout can log in on their own.

Event:

Start Date/Time:

End Date/Time:

Fee per Family:

Room:

* - denotes required fields

Family Information

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

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info*

Additional Information:

Waiver

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PARTICIPATION:

I hereby give permission for the above-named student to participate in class and performances at Angela Floyd Schools and acknowledge these classes may involve physical, athletic and recreational activities of which I represent and warrant that the above-named student is physically and mentally capable of participating.

CONSENT TO TREATMENT:

In case of a medical emergency, I authorize Angela Floyd Schools on my behalf and at my account to contact “911” and take such measures and arrange for such medical and hospital treatment as needed for the health and well-being of the above-named student without the need for further consent or permission. For matters not involving a medical emergency, I understand that Angela Floyd Schools will attempt to notify the parents and/or emergency contacts listed on the above-named student’s registration form.

WAIVER AND RELEASE OF LIABILITY:

I, individually and on behalf of the above-named student acknowledge that the student will be participating in dance class(es) and/or performances at or through Angela Floyd Schools at his/her own risk. I fully understand and agree that by participating in the aforementioned dance class(es) or performances it is possible the student may suffer an accident or other physical injury. Accordingly, I, on my own behalf and on behalf of the above-named student, do hereby specifically and expressly release, discharge, hold harmless and agree to indemnify Angela Floyd Schools, its owners, directors, officers, employees, agents, assigns, and all volunteer personnel from any and all liability, damage, injury or illness, including all acts of active or passive negligence, to the student or his/her personal property during his/ her participation in activities at or through Angela Floyd Schools. I, on my own behalf and behalf of the above-named student, further agree to indemnify and hold harmless Angela Floyd Schools for any claims brought by the student as a result of injuries sustained or damages sustained while engaging in activities at or through Angela Floyd Schools.

I further give my permission for photographs, videos and /or audiotapes of myself and the participant (s) named below, to be used in print or broadcast media ad deemed appropriate for the promotion of any AFS activities.

I've read the above and agree.

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