Balling Buccaneers - 4th Grade & 5th Grade ($250)
Thursdays 3:45-4:45 starting on February 2nd, 2023 and finishing April 20th, 2023.  Limited to 10 students.
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Student First Name *
Student Last Name *
What Grade Is Your Child In? *
Teacher's Last Name *
Will Your Child Be Attending ASP After Club? *
Parent Name *
Parent Contact Number *
Secondary Contact Number
What Is Your Best Email Address To Contact You?
Emergency Contact Name *
Emergency Contact Number *
I hereby agree to release and hold harmless the Mt. Bethel Elementary School Foundation (MBESF), its officers, trustees, and representatives and Balling Buccaneers, it's employees and representatives, from any responsibility, loss, liability, damage or costs which participant may incur in this after school program whether caused by the negligence of MBESF and/or Balling Buccaneers, the negligence of Participant and/or others, or due to accidental occurrences. In the case of injury or medical emergency involving Participant, if a parent or guardian cannot be reached, I give Balling Buccaneers program representative(s) permission to seek appropriate first aid or medical care and I agree to be fully responsible for the cost of any services provided. * * *
Does your child receive special services that may impact their participation in the club? * * *
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