KIDS & TEENS CLASSES 2012-2013
COVENANT FORM |
The form below must be completed and submitted by a Parent or Legal Guardian
The items marked * are
mandatory |
| |
| For and in consideration for being enrolled in a French class at the French Institute Alliance Française, |
| Name of Child*
(first name)
(last name) |
| Registered for*
|
which meets on*
|
| taught by*
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I, the undersigned, parent or legal guardian of the minor child listed above
agree to the following and release and hold FIAF harmless from any liability therefrom.
Please
choose ONE of the options below: |
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My child, who is over 12 years old, has permission to leave the FIAF building on his/her own after class for all classes taken in the 2012-2013 academic year |
|
My child will be released at the end of the class to the following designated
responsible adults who have met with the instructor before the start of classes and have identified
themselves as such: |
| Name* |
|
Relationship to child* |
|
| Contact number* |
|
Emergency number* |
|
| Name |
|
Relationship to child |
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| Contact number |
|
Emergency number |
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| Name |
|
Relationship to child |
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| Contact number |
|
Emergency number |
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| I agree that my child will be picked up on time. |
| A WRITTEN NOTE SIGNED BY MYSELF WILL NOTIFY THE INSTRUCTOR OF ANY CHANGES. |
I have informed the teacher of any allergies and/or medical condition that my child may have.
They are noted below: |
|
| I give FIAF permission to seek medical treatment for my child in case of emergency and if FIAF has not been able to contact me. I accept full responsibility for the cost of treatment for
any injury that may be suffered by my child while taking part in the Course. I hereby assume
all risks and hold FIAF and any instructors, harmless, from any liability, claim or injury,
damage or loss of property that may occur in connection with this enrollment. |
| |
| Your Name*
(first name)
(last name) |
| Your Relationship to Child*
|
| Your Initials*
|
| Date: 5/23/2013 |
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