Educational Workshops Registration Form

Educational Workshops Registration Form

Complete this form to register a student for one or more workshops. All fields are required unless marked optional. Submission of this form constitutes agreement to the policies, emergency medical authorization, waiver of certain claims, and payment terms described below.

Student Information

Student Name:

Date of Birth:    Student ID (if applicable):

Parent / Guardian Information (if student is a minor)

Relationship to Student:    Primary Phone:

Workshop Selection

Select one or more workshops. Fees shown are per participant.

Payment Information

Payment Method: Credit Card Check Invoice / Pay Later Installment Plan

If selecting Installment Plan, describe requested schedule and initial payment amount:

Emergency & Medical Information

Relationship:    Phone:

Policies, Consents, and Waivers

Participation Agreement and Assumption of Risk: By signing below, the undersigned acknowledges that participation in workshops may involve physical activity and other inherent risks. The undersigned voluntarily accepts and assumes all risk of injury, illness, or property loss arising from participation, except to the extent caused by the gross negligence or willful misconduct of the workshop provider.

Release and Indemnity: The undersigned releases, covenants not to sue, and forever discharges the provider, its officers, employees, volunteers and agents from all liability, claims, demands, actions, and causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant, unless arising from the provider's gross negligence or willful misconduct. The undersigned agrees to indemnify and hold harmless the provider from any claims, damages, or expenses resulting from the participant's acts or omissions.

Emergency Medical Treatment Authorization: If emergency treatment is necessary and the undersigned cannot be reached, the undersigned authorizes the provider to obtain any medical treatment deemed necessary for the participant. The undersigned agrees to be financially responsible for such treatment and any associated costs.

Cancellation and Refund Policy: All cancellations must be submitted in writing. Refunds, if any, are issued according to the provider's published refund policy and may be subject to administrative fees. Failure to attend does not guarantee refund.

Media Release: I authorize the provider to photograph and/or record the participant and to use such media for educational, promotional, or archival purposes. I do NOT authorize the use of photos or recordings of the participant.

Attendance and Code of Conduct: The undersigned agrees that the participant will comply with the provider's code of conduct and policies. The provider reserves the right to dismiss a participant for behavior that threatens safety or disrupts programming; fees may not be refunded in such cases.

Certification: By signing below, I certify that the information provided on this form is accurate and complete to the best of my knowledge, that I have authority to enter into this agreement on behalf of the participant (or I am the participant), and that I have read, understand, and agree to the terms, consents, and policies set forth above.

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