4th/5th Grade "Just Playing" Sign Up April 22-May 31st

JUST PLAYING presented by Mary Fulton Fit

Fun-ctional Training for KIDS! (6 weeks) 

FTK is a fun after school program promoting daily physical activity at every grade level and educating kids about movement through exercise. Cardio training, muscular strength and endurance building, and stretching is tailored to their level and ability.

4th/5th grade: Thursday 

Fun kid-friendly cardio activities through games, relays, hopping, and skipping. Learn starting positions for muscular endurance exercises such as modified push-ups, squats, and situps. Moving safely through basic stretches. 

When: Starting April 29-June 3rd on Thursday

Where: Henry's Garden Area

Time: 3:15-4:00 p.m.

Who can play- first 25 students who sign up.

* If raining or ground is too wet Just Playing will be made up by combining classes the following day if weather permits.*
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Student's First and Last Name *
Student's Teacher *
Parent's Name *
Parent's Email *
Parent's Phone Number *
How will the child be picked up? examples: Wrap, Kids Club, parent exc.... *
Accident Waiver

Mary Fulton Fit Liability Waiver/Informed Consent Form


 


“I, _____________________________, am knowingly and voluntarily participating in an exercise program offered through Mary Fulton Fit.  I acknowledge that the program may involve strenuous physical activity including, but not limited to, muscle strengthening and endurance training, cardiovascular conditioning and other various fitness activities.  I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this program or have been cleared by a medical professional prior to participating in the program.  My enrollment and subsequent participation is purely voluntary and in no way mandated by Mary Fulton Fit.”


 




 


“I fully understand that I may injure myself as a result of my subsequent participation in this program and I, _________________________________________, hereby release Mary Fulton Fit, and any or all of its employees, from any liability now, or in the future, for any and all conditions that may arise, directly or indirectly, as a result of my participation in the program.  This includes, but is not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, knee injury, back injury, foot injury,  other illness, soreness, or  death.”


 


I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.


______________________________________________________(Participant Name)


______________________________________________________(Participant Signature)


______________________________________________________(Minor Child’s Name)


______________________________________________________(Guardian signing for Minor Child)


________________ (Minor Child’s Age)   _____________________(Date)


__________________________________________(email address)


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Photo waiver

Just Playing, Mary Fulton Fit Company 

Student Media Authorization and Release  

I hereby grant to Just Playing, its officers, employees, and agents, service providers and assigns permission to use, adapt, modify, reproduce, create derivative works, distribute, publicly perform and display, in any form now known or later developed, my pupil’s image or visual likeness, name and/or voice, as well as writing, creations and artwork created by my pupil, throughout the world, by incorporating it or them into publications, catalogues, brochures, books, magazines, photo exhibits, motion pictures, videos, web pages, and/or other media or commercial, informational, educational, training, advertising, recruiting or promotional materials relating thereto using any means, method or media which Just Playing deems appropriate in its sole discretion and that they may be used with or without my or my pupil’s name or with a fictitious name and with fictitious or accurate biographical information. The possibility of publicity is good and valuable consideration for my signature below.  

I make this grant of rights with the understanding that no compensation will be paid to me or my pupil for such grant. I understand and agree that all right, title and interest, including copyrights, in the materials created by Just Playing pursuant to this agreement are the exclusive property of Just Playing and that I will obtain no rights in such materials. I also understand that Just Playing is not actually required to use my pupil’s name, photograph, likeness, image, voice, signature, writing, creations or artwork in any way.  

I hereby waive any right that I or my pupil may have to inspect or approve any photograph, likeness, image, video, audio recording, creation or derivative work thereof made pursuant to this Student Media Authorization and Release. I understand that under California law individuals have the legal right to control the use of their names, likenesses and images and I hereby release all such rights and hold harmless Just Playing, its agents, licensees, and assignees from, and will neither sue nor bring any proceeding against any such parties for any liability, whether now known or arising hereafter, resulting from or arising in connection with the exercise of such parties’ rights pursuant to this agreement.  

I have read the above agreement and fully understand its contents. I represent and warrant that I am at least 18 years of age, that I have the right to contract in my pupil’s name, and that neither I nor my pupil has any pre-existing obligation that may restrict or limit my ability to sign this Student Media Authorization and Release.  

This Student Media Authorization and Release will be governed by the laws of the State of California and represents the final and exclusive agreement between Just Playing and myself on this subject.  

I warrant that I am the legal guardian of the minor being photographed or whose likeness and/or creations will appear in photograph(s) or other media as designed by just Playing and agree to the above.  

I give my consent and agree to the terms above:  

______ _______________________ ___________ Parent/Guardian Signature Date  

___________________________ ___________ Parent/Guardian Signature Date  

_________________ _____ Pupil Name (Please Print)  

________________________Patrick Henry_____ School Site  

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