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Register for East Bay Innovation Academy After School Program Winter 2018-19. Classes are on Tuesdays, Wednesdays, Thursdays and Fridays from Nov 7, 2018 – Feb 15, 2019, 3:50 – 5:30 pm

•Tuesday's - Drumming Jam! African drum, dance & body percussion adventures

• Wednesday's - World of Dance! Hip-Hop, funk, latin, caribbean & more...

•Thursday's - Capoeira & afro-brazilian arts adventures! Martial arts, stick dance & more...

•Friday's - Let Go! Relax 'n Recharge yoga, fitness fun & energizing games

Parent's Name *
Parent's Name
Address
Address
Phone *
Phone
Children Registering *
Child's Name *
Child's Name
Second Child's Name
Second Child's Name
To the best of my knowledge, my child is in good physical condition and fully able to participate in this course. I am fully aware of the risks and hazards connected with the participation in this class, including physical injury, and hereby elect to allow my child to participate in said class, knowing that the associated physical activity could be hazardous to her/him. I voluntarily ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY that may be sustained by my child, or loss or damage to property owned by me, as a result of participation in this course. I hereby RELEASE, WAIVE, DISCHARGE, as COVENANT NOT TO SUE Get Empowered staff from ally liability, claimed demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury that may be sustained by my child, or to any property belonging to me, while participating in physical activity, or while on or upon the premises where the course is being conducted. In signing this release, I acknowledge and represent that I have READ The Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT and SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE RELEASE FOR FULL, ADEQUATE as COMPLETE CONSIDERATION FULLY intending TO BE BOUND BY SAME. Acknowlegement.
Class or date attending *

PAYMENT