Spring 2021 – Private Class Intake Form

Release

I hereby enroll my child for physical training in the Kidokinetics program.

Medical Information

Photo Release

Pictures of your child participating in our fun classes may be included on the Kidokinetics.com website or other advertising materials. The child’s name will not be disclosed. Please circle below indicating whether your child’s pictures may be used by Kidokinetics. Inc. All photographs are the sole property of Kidokinetics, Inc.

By signing below and selecting “authorize” above I hereby grant permission for Kidokinetics, Inc. to use any pictures or photographs of my child on the Kidokinetics.com website, or other advertising materials including, brochures, pamphlets, or newspaper articles. I also acknowledge that these pictures / photographs are the property of Kidokinetics, Inc. and that no royalties or payments are due in connection with their use.

Responsibility for Payment/Release

The undersigned agrees to be responsible for and to pay Kidokinetics, Inc. for all charges associated with the enrollment and participation of the child listed above in the Kidokinetics program. The undersigned, on his or her own behalf and on behalf of the child listed above, hereby releases Kidokinetics, Inc. from any and all liability arising out of or connection with the above listed child’s participation in any Kidokinetics, Inc. program, even though that liability may arise due to negligence or carelessness on the part of Kidokinetics, Inc., its officers, agents or employees, and further, on behalf of myself and the child listed above, waive any and all claims of any kind against Kidokinetics, Inc., its officers, agents or employees arising from or in connection with the services provided by Kidokinetics as part of its programs.

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