Registration - dasanasports.com

DASANA SPORTS REGISTRATION FORM

Registration Form School Year*

Parent/Guardian Full Name*

E-mail*

Phone Number*

Address

Student 1 name*

Age*

School*

Grade*

Student 2 name*

Age*

School*

Grade*

Medical/physical conditions, allergies, additional information.

Class Location*

Please note: Parent/Guardian listed above assumes primary responsibility for account payment. If the student is using school funds, please contact your school to place a purchase order or school approval before the first day of class. Payment and a current account are required to secure a place in each class. Class sizes limited.

I Agree

Payment type

Cash
Check
School funds

Date*

Date

By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above student(s), agree to release "DASANA SPORTS", including instructors, assistants, and volunteers from liability for any and all injuries which may occur while training, practicing, playing, or during any Dasana event or activity. You also agree that you are responsible for health and accident insurance and any medical costs incurred due to injury. You also give your permission for the public display of any visual images that your child may appear in.

I Agree