Fuel Up with Friends After-School Program - Upton Spring Program 2024
Registration and Liability Form 
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Student Name *
Nickname
Grade *
Required
Please list your child's teachers name  *
Parent/Guardian Name *
Parent/Guardian Email Address *
Parent/Guardian Cell Phone Number *
Emergency Contact Name (other than parent/guardian previously listed)  *
Emergency Contact Phone Number (other than parent/guardian phone number previously listed) *
Does the participant have any food allergies or dietary restrictions? If so, please specify. If no, please type NA *
Do you give permission for photos to be taken of your child during class time and for these photos to be posted on social media and/or Fueling Up Our Future's website (no names will be listed)?  *
Required
Will your child be attending latchkey at the end of the class at 4:30? If so, we will take your child there.  *
Required
Please list the names of people who will pick your child up at 4:30 or advise if your child is allowed to walk home by themselves? 
 *
Please initial below acknowledging the following: I fully understand and acknowledge that my child's participation is voluntary, that Fueling Up Our Future's food, nutrition and yoga programs have inherent risks, dangers and hazards and that my child's participation in such classes may result in injury or illness. Such risks may include, but are not limited to, the risk of physical injury or harm involved with exercise. My child has no medical conditions that I am aware of which would prevent them from taking part in yoga classes or nutrition workshops, and I assume responsibility for any risk or injury sustained as a result of participation. I further agree to hold harmless Sara Piatt and Christy Scott along with any other assistants or volunteers from any and all claims arising out of injury to my child as a result of their participation in our programs.  *
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