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Kidsboxing Fall 2019

Beth Torah Kidsboxing Enrollment Form Fall 2019


If you are a Member of Beth Torah and are NOT already logged into your Beth Torah account please do so now to take advantage of Member only pricing.

Non-Member Tuition Pricing:
Non-Member Tuition Price      Regular Rate        $225
Additional Non-Member Children     Regular Rate         $210
Member Tuition Pricing:
Member Tuition Price     Regular Rate         $200
Additional Member Children     Regular Rate         $180


Student 1 - Student Information






Student 1 - Health Information

The information provided in this section will be used by our staff to support your child(ren) in class. If there is additional information you wish to share (or that is confidential/private), please feel free to email us at admin@bethtorah.ca. We encourage all students to have a current medical examination before attending class.
 



 

 


 

 



Student 2 - Student Information






Student 2 - Health Information

The information provided in this section will be used by our staff to support your child(ren) at school. If there is additional information you wish to share (or that is confidential/private), please feel free to email us at admin@bethtorah.ca. We encourage all students to have a current medical examination before attending school.
 


 

 


 

 



Student 3 - Student Information





Student 3 - Health Information

The information provided in this section will be used by our staff to support your child(ren) at school. If there is additional information you wish to share (or that is confidential/private), please feel free to email us at  admin@bethtorah.ca. We encourage all students to have a current medical examination before attending school.
 


 

 


 

 



Student 4 - Student Information






Student 4 - Health Information

The information provided in this section will be used by our staff to support your child(ren) at school. If there is additional information you wish to share (or that is confidential/private), please feel free to email us at admin@bethtorah.ca. We encourage all students to have a current medical examination before attending school.
 


 

 


 

 



Parent 1 / Guardian Information




Parent 2 / Guardian Information




Emergency Contact and/or Alternate Pick-up


This is a person over the age of 18 who is authorized to pick up your child and can be contacted by Beth Torah when the parent/guardian can not be reached.

Parental Consent


Refund Statement

Requests for refunds must be submitted in writing to the Beth Torah offices (either via email or in hard copy). All requests will be subject to review and an administrative fee of $25. No requests will be granted if received after two (2) weeks before the start of class.

Refunds will not be granted for inclement weather or cancellations beyond our control.

A doctor's note will be required for refunds based on medical reasons.


Consent Statement

I give my consent to the taking of photographs and/or video records of my child(ren) by Beth Torah Congregation and waive any rights I have related to any such photographs and/or video recordings. I also give my/our consent to the use of any such photographs and/or video recordings, in whole or in part, by Beth Torah Congregation.


Assumption of Risk and Indemnifying Release

While Beth Torah staff and instructors will make every reasonable effort to minimize exposure to known risks associated with each Registrant's (defined below) participation in a Beth Torah program ("Program"), I hereby acknowledge that I and/or my child(ren) if I am registering on his/her/their behalf (collectively, the "Registrant(s)") may be required, depending on the nature of the Program, to participate in various physical activities that may involve risk of injury. In this regard, I agree that I have provided (if required) a complete and accurate health history and hereby permit the Registrant(s) to participate in the full range of Program activities, except as specifically noted by me in the health information section of the Program registration (where applicable). In consideration of the Registrant's(s') opportunity to participate in the Program, the receipt and sufficiency of which is hereby acknowledged, I hereby release and forever discharge Beth Torah, its respective officers, directors, employees, volunteers and agents, and their respective successors and assigns, from any and all liabilities for damages sustained in consequence of loss, injury or damage to the Registrant, and from all other actions, causes of action, claims, demands or damages of any kind with respect to death, injury, loss or damages to any person or property arising out of or connected to preparation for, or participation in, the Program.


Medical Emergencies

In the event of an accident, injury or illness involving the Registrant, where immediate contact by Beth Torah with a designated contact cannot be made, I hereby authorize and grant permission to Beth Torah to secure proper medical treatment and authorize on the Registrant's(s') behalf all procedures, including (without limitations) admission to an emergency unit, hospital and treatment therein, ordering of x-rays, tests or treatment, injections, anesthesia and/or surgery, as deemed necessary by the attending medical professional(s). I agree not to hold Beth Torah responsible for any costs or injury arising out of an emergency situation.


Disclaimer

All programs and busing are subject to change or cancellation due to low enrollment or other unforeseen circumstances that are prohibitive to the operation of the program or bus.


Registration Agreement

By checking below, I acknowledge that I have carefully read and understand all statements and policies listed above.


Sat, 19 October 2019 20 Tishrei 5780