Children After School Programs Four Installments (St Timothy Catholic School)

If you choose to pay the school year term, we offered 4 installments

Student

Full Name *

DOB

School name *

Grade

Add sibling

Full Name

DOB

Address

City

Province

Postal Code

Phone

Parents

Mother’s Full Name

Phone

Father’s Full Name (Copy)

Phone (Copy)

Emergency Contact

Please list two persons to notify in case of emergency

Full Name:

Relationship

Other relationship

Phone

Full Name: (2)

Relationship (2)

Other relationship

Email (2)

Phone (2)

Terms & Conditions: All fees are paid in full, up front at time of registration. HOLA does not issue refunds for missed classes or cancelled classes. HOLA reserves the right to change the time and duration of each class with prior notice. Media Release: In consideration of my child(ten)’s attendance and participation at HOLA. I, the undersigned, hereby agree and give my permission for HOLA and/or partners to record, film, photograph, audiotape or videotape my/my child’s name, image, student work, and performance (hereinafter collectively referred to as “Works”) and to display, publish or distribute these Works for the purpose of publishing, posting on the HOLA website, posting in schools, posting on social media sites and/or for broadcasting as determined by HOLA I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I waive any right to any royalties related to the use of these Works. I understand that the Works may appear in electronic form on the internet or in other publications outside of HOLA’s control. I agree that I will not hold HOLA responsible for any harm that may arise from such unauthorized reproduction. I also understand that external media organizations may attend school events. I give permission for my/my child’s name, image, student work, and performance to be photographed, filmed, audio-taped or videotaped for the purpose of being published and/or broadcast online, on television or radio.

Signature *

I accept the Terms and Conditions.

Notes

Please share anything we need to know about your child-ren and how do you want us to do if that’s the case. For example: allergies, medications, medical condition, etc

Children

Adults

Corporate

Children

Adults

Corporate