Taller en Acción

TALLER EN ACCION REGISTRATION FORM

PERSONAL DATA: Participant

First Name

Last Name

Age

Date of Birth

Sex

Address

FAMILY DATA:

Father's name

PHONE NUMBERS:

Phone

Ofi

Mobile

Mother's name

PHONE NUMBERS:

Phone

Ofi

Mobile

PEOPLE AUTHORIZED TO PICK UP THE PARTICIPANT: (Place name and last name)

(No participant could be withdrawn if the person is not authorized in this form)

MARK THE WEEKS IN WHICH YOUR REPRESENTATION WILL PARTICIPATE

Checkbox Field

SPRING BREAK

SUMMERCAMP

MEDICAL RECORD

Does the child have a physical disability or illness?

Is the child allergic to any medication and/or food?

Does the child take some type of medication?

Credit Card Authorization

Type of Credit Card:

Security Code

Name as it appears on the card:

Credit Card Number:

Expiration Date

Phone Number of Cardholder

Billing Address of Cardholder

I authorize that the debit be made according to the program.

Date

RESIGNATION AND RELEASE OF LIABILITY

I, the undersigned, understand that participation in performing arts classes / activities may involve a risk of accidental injury, despite all safety precautions. I hereby release Taller en Accion Arts Academy, its officers, agents, employees and volunteers and PV International Sports Kid, from all liability or claims that may be sustained by the participant named here, or a third party directly or indirectly in relation to, or arising from, of participation in the activity described in this document, whether caused, in whole or in part, by the negligence of Taller en Accion Arts Academy, PV International Sport Kids or otherwise.

I certify that the named participant is fully covered by medical insurance and that I am fully responsible for all costs incurred. I further certify that the previous participant is in good health and free of injury.

INITIALS:

legal guardian of

expressly agree and accept all the clauses and conditions stablished by the Camping Organizing Committee, and based on them, I register my kid being understood that no claim subsequent to the signing of this agreement will be taken into consideration. Therefore, the complains related directly or indirectly to the content of some of the clauses described above, will not have support or validity.

Signature of the Representative:

Father’s signature:

Mother’s signature:

Important note: Registration of the participant will not be effective if this form is not duly signed by the parent/legal guardian.

GENERAL CONDITIONS

1. Summercamp / Springbreak will not allow objects or appliances that are not requested or required in the registration form or in any communication specially issued in this regard therefor the organization will not be responsible for the loss or total or partial damage of any of the objects described above and will not be at any time cause for complaint by Parents or Guardian.

2. The accessories that the parents deem convenient to send for the well-being of their representative, must be notifyed in writing to the Management of the Summercamp. Still, we will not be responsible for those, nor for the money that the campers carry.

3. It is strictly mandatory, that each camper brings all his clothing identified with his name, both the uniform and other accessories. This mark must be placed on the inside of it.

4. The parents and (or) guardian, will be able to observe the activities that the children realize, as long as they do not interfere with it.

5. The parents and (or) guardian will be strictly forbidden to exceed the safety limits established by the staff of the summercamp in the different areas such as: dining room, fields, special activities, swimming pools, among others.

6. Once the payment is made, the parents and (or) guardian will not be entitled to the refund of the money. Under no circumstances (this includes absence due to illness, suspension due to inappropriate behavior, problems of adaptation, if you arrived late to the fieldtrip departure or any other reason).

7. The Parents and (or) guardian must inform the Summercamp Organizing Committee in writing, the contraindicated medications for the campers, as well as their medical history, allergies and any other information considered necessary and indispensable in case of an emergency.

8. The parents and (or) guardian will accept that any other expense that derives from illness or accident of the camper, not covered by the referred policy must be paid by them.

9. The parents and (or) guardian will accept that the admission and permanence of the campers within the camp is subject and expressly conditioned to it complying with all the rules, policies (conditions), and camp order practices.

10. The participant will not be allowed to attend the weekly fieldtrip if he does not bring the summercamp uniform. Under no circumstances will it be allowed, for reasons of extreme security.

11. Under no circumstances will children be received at the place of the fieldtrip, if the camper does not arrive at the scheduled time to leave. If the minor does not attend the fieldtrip, he should be taken to the facilities of the summercamp only when the rest of the group arrives.

12. The distribution of the children will be made by age groups and level of development that in the opinion of the summercamp manager is considered for the shelter of the camper and the group. Under no circumstances may parents interfere in this decision.

13. Under no circumstances will the campers be allowed to enter the summercamp without their representative.

14. It is mandatory that parents sign the children’s attendance on a daily basis both at the entrance and at the exit.

15. The Summercamp will be responsible for its representative starting at 8:00 a.m. until 5:00 p.m. The permanence of the same in the camping outside the established schedules, will cause a fine of $ 10 for every 15 minutes of delay.

16. As a parent / legal guardian I authorize Taller en acción and PV International Sport Kids to use and display the images in which my minor appear in activities, competitions, etc. carried out within their facilities or in which they attend with the same, and the companies may published on social networks.