Junior Diamond Club

Registration Form

Student Information

First name

Last name

Student Gender

Student's Birthdate

Student's Grade in School

Teacher's Name

Aftercare or Pick-Up

Authorized Pick-Ups

Parent Information

First Name

Last Name

Parent's Email

Parent's Primary Phone Number

Additional Phone Numbers

Session

Agreements

Parent Waiver

I hereby release and agree to indemnify and hold harmless: Chi Chi Gonzalez LLC, Palm Beach County Schools, Calusa Elementary and all instructors from any liability and against any and all claims resulting from participation in this program, with my knowledge that by participating in this activity my child assumes risk of injury. I also hereby give permission to Chi Chi Gonzalez LLC to use and display any photographs taken of my child, which may be forwarded to newspapers and other publications in which the photograph would be associated with Chi Chi Gonzalez LLC

Disclosure

Junior Diamond Club by Chi Chi Gonzalez LLC is not affiliated or endorsed by the school board of Palm Beach County or Calusa Elementary School, and the events/activities hosted by Chi Chi Gonzalez LLC on Calusa Elementary premises persuant to a lease agreement shall not be construed as being conducted, funded hosted or sponsored by the school board and Calusa Elementary on behalf of Chi Chi Gonzalez LLC. the School board and Calusa Elementary undertake no responsibility for supervising or monitoring Chi Chi Gonzalez LLC events/activities and will not be liable for any and all actions of Chi Chi Gonzalez LLC on Calusa's premises.

Signature

Parent Signature

Payment

Payment options