Child's Name
*
First Name
Last Name
Child's Gender
*
Select One
Child's Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Child's School Name
*
Child's Date of Birth
*
MM
DD
YYYY
Child's Race (Select all that apply)
*
Child's Ethnicity (Select One)
*
Parent/Guardian Name
*
The parent/guardian should be the person completing this form.
First Name
Last Name
Parent/Guardian Phone Numer
*
We will call and text this number.
(###)
###
####
Do you authorize the self dismissal of your child from The Armory?
*
The Great Minds program ends at 5:00 PM. If your child is authorized for self-dismissal, they will be dismissed after class WITHOUT an adult there to pick them up.
Names of the people who HAVE PERMISSION to pick up your child
Please include their full name, relationship to the child, and phone number
Emergency Medical Treatment
*
My child is enrolled as a participant of Armory College Prep. In the event of a medical emergency, I hereby give consent for necessary emergency medical treatment for my child to be obtained, with the understanding that I will be notified as soon as possible. I understand that every effort will be made to contact me, or, if I am unavailable, the emergency contact listed below, before and after medical care is provided.
Medical Emergency Contact Information
In the event of a medical emergency, where I cannot be reached, I designate the following person as an emergency contact.
Child's Health Condition
*
Health and safety are our top priorities at The Armory Foundation. Are there any social, emotional and/or physical health conditions that our staff needs to know about? Examples of health conditions include, but are not limited to allergies, asthma, developmental disabilities and/or intellectual disabilities.
Health Safety and Behavior Agreement
*
The Armory Foundation is committed to providing a safe, positive, and growth-driven environment for all children who participate at The Armory. Please review the following expectations that guide our behavior management when onsite at The Armory.
Expectations:
- Children must keep their hands and feet to themselves at all times.
- Children must follow all instructions set forth by staff members.
- Children must refrain from damaging any property.
- Children must refrain from disruptive behavior, fighting, violence of any kind, and inappropriate language.
A child may be immediately dismissed from the event if their behavior is determined to be detrimental to well-being of others in the program. Immediate dismissal of an entire family may occur in the event of inappropriate behavior of parents at The Armory. Adults are expected to model the desired behavior that is expected of the children. Profanity, threats, or disruptive behavior will not be tolerated. Please discuss the information listed above with your child. We appreciate your efforts and thank you for the continued support in making appropriate behavior a priority for all children.
General Consent
*
Please Read and Indicate that You Understand *
There are inherent risks and potential for injury when participating in programs such as Great Minds, including but not limited to falls, contact with other participants or visitors, conditions on the track, in the classroom or elsewhere, and physical exertion. My child and I hereby assume all such risks and responsibility for any and all injury, damage or loss that may result from participation in Armory programming, including those risks that result from the negligence of Released Parties and others. I consent to treatment in the event of an emergency or other incident and agree to pay all costs associated with such medical care. I confirm that my child is physically fit to participate and is not subject to any medical condition that poses any risk of harm to him/herself or others.
I, for myself, my child, and anyone entitled to act on our behalf, do hereby release the The Armory Foundation, the City and State of New York and its agencies and officials, Nike, Inc., and all other sponsors of The Armory Foundation and the directors, officers, employees, insurers, volunteers, representatives and successors of all of the foregoing (“Released Parties”), from any and all present and future claims and liabilities of any kind, known or unknown, arising out of my presence or my child’s participation, even if it is due to the negligence of the Released Parties, to the fullest extent permitted by law.
I consent to the participation in interviews, the use of quotes, and the taking of photographs or video, use of name, biographical and other data, image, personal property, or any other aspect of my attendance or that of my child. The text, image(s), and/or video may appear in electronic form on media websites, in corresponding publications, in print or in broadcast by any of the Released Parties and their affiliates and licensees. I also grant the right to the Released Parties to edit, use, copyright, in all media and in any manner and reuse said material for promotional purposes including use in print, on the internet, and all other forms of media without any additional consideration.
I understand and agree that I am responsible for my child’s eligibility and/or amateur standing under various associations and the NCAA.
Any dispute between me and the Released Parties shall be settled by arbitration administered by the American Arbitration Association under its Commercial Arbitration Rules and the decision of the arbitrator shall be final and binding upon all parties. While at The Armory, my child and I may be exposed to ideas, designs, inventions and other confidential information and my child and I have no rights to any such information.
By checking yes below, I authorize The Armory Foundation to send text messages to my cell phone to convey information about programming. I understand that standard text messaging rates may apply to any messages received from The Armory Foundation.
