Virtual Spring Break
Hello! We are so excited for you and your youth to participate in our virtual spring break for 2021! The program will take place Monday, March 29-Friday April 2. We are so glad we were able to pivot and provide this opportunity for youth to keep moving even though we cannot meet physically. Our enrichment teachers will tailor the lessons for youth in grades K-5 but if you have younger ones feel free to guide them through the lessons as well. You will receive more information from us in the days and weeks to come but for now tell us more about your child! Please do one form for each child. Thank you!
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Email *
Child's First Name *
Child's Last Name *
Child's grade in school *
Parent/Guardian First & Last Name *
Parent/Guardian Email address *
Parent/Guardian Mailing Address *
How many people live in the home (adults & children)?
Clear selection
Approximate Household Income
Clear selection
Enrichment Choice(s)-choose as many as your child would like!
Allergies or food restrictions? If your child would like to follow along with the cooking demos please list any food allergies or dietary restrictions and we will follow up with alternatives
Waiver
Waiver: I know that participating in the activities of the Kids Moving & Thriving Winter Break is  potentially hazardous. I should not enter unless I am medically able and properly trained. I assume all risks associated with participating in this event including, but not limited to: falls, contact with other participants, and the effects of the weather, all such risks being known and appreciated by me.

Having read this waiver and knowing these facts and in consideration of your accepting my
entry to participate in the Kids Moving & Thriving Virtual Spring Break (herein after the “Event”) I, intending to be legally bound, do hereby for myself, my heirs, my executors and administrators agree as follows:

1. I do waive and forever release any and all rights and claims for any damages and liabilities of any kind arising out of my participation in the Event against all persons, entities and agencies involved with promoting and holding the Event, including but not limited to Kids Moving & Thriving, sponsors, volunteers and vendors of the event, their agents, successors, representatives and assigns even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

2. I assume the risk of all bodily injuries, including death and personal injuries to me and damage to and loss of my property, including loss of use thereof and any other indirect or consequential damages, resulting directly or indirectly, wholly or in part, from my participation in the Event and while traveling to and from the Event.

3.  I hereby agree, for myself and/or for a minor under the age of eighteen for whom I am signing, to indemnify, defend, and hold the entities named above harmless from and against any and all claims, liabilities, losses and damages, costs, expenses (including attorney’s fees) judgments and penalties arising out of any of my, and or said minors, acts or omissions to act.

4.  I understand that the Event reserves the right to use any and all participants’ names, pictures, videos and/or likeness with regard to promotional and/or advertising materials.

5.  *For participants under the age of 18 only. I sign this release on his/her behalf, and hereby agree to indemnify and hold harmless tournament sponsors, their agents or representatives, from any loss, damage or expense sustained or incurred by them arising from any claim, cause of action or liability which may be brought by my minor child. I sign this release on his/her behalf.
Parents/Guardians: If you agree to the above waiver please sign by typing your name below
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A copy of your responses will be emailed to the address you provided.
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