Hide-A-Bug Challenge with Professor Bugman!

 Animals need shelter, and it's up to your children to use our forest-gathered materials to build a shelter fit for a bug.   Not just any bug, but our residential judge, Mr. Cranky B. Cockroach!   Will he approve of your shelter and find safety within, or will he hiss and make his way to more suitable real estate?

Date: Wednesday, January 25th 3:00-4:15pm.

Grades: K-5

$15/student. Max 18 students.

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Email *
Student First Name *
Student Last Name *
Student Grade *
Guardian Full Name *
Guardian Email Address *
Guardian Phone Number *
After the program, my student will: (pick one)
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Who Will Pick-Up Your Student? If different then above, provide phone number. *
REVENUE DISCLOSURE:
The total amount of revenue from the class depends on the number of children registered. The program instructor receives all proceeds, minus  10% for administrative costs (which goes to LINK).
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Required
RELEASE AND WAIVER

In consideration of participating in the after school program at Berlin Memorial School, I, the child(ren)’s parent and/or legal guardian  represent that I understand the nature of the activities and that the above named child(ren) are qualified, in good health, and in proper  physical condition to participate in such activities. I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue  participation in such activities. I fully understand that the activities involve risks of serious bodily injury, including permanent disability,  paralysis and death, which may be caused by my own actions, inactions, those of others participating in the event, the conditions in which  the event takes place, or the negligence of the “releasees” named below; and that there may be other risks either not known to me or not  readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a  result of my participation in the activities. I hereby release, discharge, and covenant not to sue the after school program instructor(s), Berlin  Memorial School, LINK, Inc, or their respective administrators, directors, agents, officers, managers, members, volunteers, and employees,  other participants (the “Releasees”) from all liability, claims, demands, losses, or damages, on the child(ren)’s account caused or alleged to  be caused in whole or in part by the negligence or the Releasees or otherwise, including negligent rescue operations and future agree that if,  despite this release, waiver of liability, and assumption of risk I, the child(ren) or anyone on my or the child(ren)’s behalf, makes a claim  against any of the Releases, I will indemnify, save, and hold harmless each of the Releases from any loss, liability, damage, or cost, which  any may incur as the result of such claim, including without limitation litigation expenses and attorneys’ fees. I have read the Release and  Waiver and understand that I have given up substantial rights by signing it freely and without any inducement or assurance of any nature and  intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this  agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. 

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Required
Please list any current or previous accidents, illnesses or physical limitations that would stop or prevent your child from participating in the  after school program; otherwise, please state “NONE”. Any information you provide will help us to better teach your child. For example,  hearing problems, ADD, delayed motor skills, prior injuries, etc.

Allergies:
Medications:
Physical Limitations or Situations:
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Liability & Waivers Read and Agreed to by Parent/Guardian: *
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