After School Agreement - West


Letterhead - Color

Location: 

Parent/Legal Guardian’s Information: 

First Parent’s Information:
First Name:  Last Name:  DOB:
Home Phone: Cell Phone:
Work Phone:  Email Address:
Second Parent’s Information:
First Name: Last Name: DOB:  
Home Phone: Cell Phone:
Work Phone: Email Address:
Home Address:   
City/Town: State: Zip:

Member Information:

First Member’s Information:
First Name: Last Name:  DOB:
School Name:  Grade:
Number of Days Attending Per Week and Rate: 
Second Member’s Information – If Applicable:
First Name:  Last Name:  DOB:
School Name:  Grade:
Number of Days Attending Per Week and Rate: 
Third Member’s Information – If Applicable:
First Name:  Last Name:  DOB:   
School Name:  Grade: 
Number of Days Attending Per Week and Rate: 
Days Attending Each Week

Program Start Date:
Program End Date:   

 Payment Information:

Card Holder’s Name as it Appears on Card:  
Credit Care Type:  Credit Card Number:  Expiration Date: V-Code: Billing Zip Code:  
Payment Cycle:
 
ACKNOWLEDGEMENT:
I have read this agreement and understand that once it is signed by me, it is a legally binding and enforceable obligation and I agree to comply with all the provisions, terms and conditions as this agreement set forth.   I also authorize Dragon Yong-in Martial Arts to charge my credit card for tuition that is owed.
As we are all aware, children are prone to mishaps. Although Dragon Yong-In Martial Arts makes every effort to have adequate supervision, ocassionally accidents can happen. In the instance that an emergency arises we would need your specific permission to transport and have your child treated by a professional care giver/physician etc.
For the safety and well-being of our students and staff, Dragon Yong-In Martial Arts reserves the right to remove any child from our program.
We require a physical from your physical stating that the student(s) above is/are in adequate physical health to participate in our Tae Kwon Do Program.
I agree to waive any and all claims again persons connected with Dragon Yong-In Martial Arts.
As we all are aware, children are prone to mishaps.  Although we will give every effort to have adequate supervision, occasionally accidents will happen. In the instance that an emergency arises this contract authorizes Dragon Yong-In to transport and have my child(ren) treated by a professional care giver/physical etc.
This contract serves as permission to have my child(ren) transported and to receive any and all emergency health care needed in the case a situation does arise.
This contract also serves as specific permission to pick up our child from their respective schools and transport them back to Dragon Yong-In Martial Arts school for Tae Kwon Do, snack, homework assistance, playing games and other activities.
If you wish to cancel this agreement you may cancel by written notice with two weeks’ notice to the school.
I authorize Dragon Yong-In Martial Arts to allow my child(ren) to participate in all field trips. This includes participate in all events in which my child is a team member or participant.

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Dragon Yong-in Martial Arts https://dragonyong-in.com
Signature Certificate
Document name: After School Agreement - West
Unique Document ID: 0552a1651de0ae1f3d587d3916e08288982a9cfe
Timestamp Audit
June 17, 2016 1:59 pm ESTAfter School Agreement - West Uploaded by DYMA Sales - sales.dyma@gmail.com IP 71.207.145.17