Enrollment Form

TrainingWheelz, 2011-2012
Please note that all fields followed by an asterisk must be filled in.
Participant's Name*
Participant's Date of Birth*
Insert Name of the School Participant Attends
(N/A If Not Applicable)*
Sibling(s) Name
N/A if Not Applicable*
Sibling(s) Date of Birth
N/A If Not Applicable*
Insert Name of the School Participant's Sibling Attends
N/A If Not Applicable*
Parent or Guardian's Name*
Name & Number
Person Who Receives Text*
Last Name*
E-mail Address*
Street Address*
City*
State/Prov*
Zip/Postal Code*
Home Phone*
Business Phone*
Emergency
Contact Name & Relationship*
Emergency
Contact Phone*
Student(s) May Be
Picked Up By
(Someone Other
Than Parent)*
Please Select Your Preference*
P.M., 2:41 - 6:00, $30 Ea.
Is Participant
an AAU Member?*
Yes
No
Allergies or
Special Needs?
N/A if not applicable*
How Did You Hear About TrainingWheelz?*
Fee Disclosure*
A one-time 'annual' registration fee of $25 is required for all new participants in Symbolic Art programs; Weekly rates: Morning session $50, & Afternoon session $30. Daily rate: Morning, $10 - Afternoon, $6 applies to TrainingWheelz participants who are dropped off or picked up and signed into the program.

Weekly Rates apply to participants who come to the program at least four days out of the week. Payments may be made in cash, money order, check, credit card or PayPal. Payments will only be accepted from adults listed on this form; Payments are due the Friday prior to a new week. A $5 late fee will be assessed for each :15 min past 6:00 p.m.

Sign-In & Sign-Out*
To protect the safety of our children I understand each child must be signed in and out daily. The only person(s) authorized to pick up the child(ren) are those listed on this form; a photo ID must be shown as staff becomes familiar with the person(s) picking up the child regularly
Waiver of Claim*
For ourselves, and/or on behalf of our child named above, our heirs, executors, and administrators, we hereby do expressly and forever waive and release The Rock of Israel, Christian Fellowship, Symbolic Art and their respective officers, employees, agents or representatives from any and all liability for personal injury or damages, sustained, incurred, arising from or connected with travel to, return from any and all classes, tournaments and/or special events, and all activities related to, or in connection with said activity by ourselves or by our child.

During programs or events sponsored by R.O.I.C.F and Symbolic Art staff may take photos or video of participants that may be used in professionally designed publications, social media networks and other promotional materials

Parent Letter*
I have received, read and understand the contents of the parent letter
Please Type Your Name*

Please enter the word that you see below.