Emergency Contact and Liability Release
Weekly Kidokinetics Multi-Sports Sessions at Tutor Time on W. Bell Road (6081)
Wed, Apr 30, 2025 - Ongoing
Tutor Time West Bell
Kid(s)
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First name
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Last name
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Dob (mm/dd/yyyy)
-- Select a size --
18-24 months
2 Toddler
X-Small (2-4yrs)
Small (4-5yrs)
Medium (6-7yrs)
Large (8-9yrs)
X-Large (10-11yrs)
*
T-shirt
Medical info (please list all medicines, allergies, etc)
Another Kid
Parent / Guardian Emergency Contact
*
First name
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Last name
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Email
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Mobile phone
*
Address
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City
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State
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Zip code
I agree to photo release (optional)
- view
I understand and grant permission to Kidokinetics coaches/staff to take photos of my child during the Kidokinetics sessions with the sole purpose of sharing these photos with me and with the parents of other participants in the session. These photos will not be used for any marketing purposes. If I wish to not allow for pictures of my child to be taken, I agree to notify Kidokinetics in writing, at such time my account will be noted and no pictures of my child will be taken or shared.
Parent / Guardian e-Signature
The undersigned, on his or her behalf and on behalf of the child listed above, hereby releases Kidokinetics from any and all liability arising out of or connected with the above-listed child’s participation in any Kidokinetics. The program, even though that liability may arise due to negligence or carelessness on the part of Kidokinetics, 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., its officers, agents or employees arising from or in connection with the services provided by Kidokinetics as part of its programs. You acknowledge that photos and videos of my child may be shared with classmates, parents, and teachers at my school through Classdojo and/or through email. By agreeing, you also consent to be contacted by Kidokinetics by email, SMS, and/or phone regarding your student.
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