Kids Cooking Classes JASC

Kids Cooking Classes Registration Form

February Class
Cooking classes will be held at:

5700 N Lincoln Ave, Chicago, IL 60659.

Classes for children ages 6-14 years old.

For any questions, please contact: programs@jasc-chicago.org.
Parent/Guardian Name*

First NameLast Name
E-mail*
example@example.com
Best phone number to reach parent/guardian*
This is phone my

HomeWorkCell/Mobile
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a JASC member?*

Yes, I am a JASC memberNo, I am not a JASC Member
Will you be registering another student for the cooking class?*

YesNo
If your child is attending the class with another student who is registering separately and wish to be seated together, please enter their name below.

Student Information
Name of Student*

First NameLast Name
Date of birth of Student

MonthDayYear
Date
List all food allergies Student has (type N/A if none):*
Caregivers: Are you able to stay during the class?

Yes, I would like to stay and volunteer as a class assistantYes, I would like to stay and wait in the activity room until class is overNo, I will go home and return for pick-up

Student #2 Information
Name of Student #2*

First NameLast Name
Date of birth of Student #2

MonthDayYear
Date
Name of Student #2 Parent/Guardian*

First NameLast Name
Student #2 Parent/Guardian Email*
example@example.com
Student #2 Parent/Guardian Phone Number*
Please enter a valid phone number.
List all food allergies Student #2 has (type N/A if none):*
If you want to register additional students, please fill out this form completely, submit it, and fill out a second form for your additional students. Thank you.

Emergency Contact and Pick Up Procedures
Name of Emergency Contact*

First NameLast Name
Relationship to student*
Phone Number of Emergency Contact*
Please enter a valid phone number.
Additional Pick-up Person

First NameLast Name
Additional Pick-up Person Phone Number
Please enter a valid phone number.
If someone other than the parent or guardian or emergency contacts listed here is picking your child up, you MUST LIST THE INDIVIDUAL with FULL NAME and with PHONE NUMBER. The individual who picks up your child(ren), MUST SHOW identification (driver's license, state ID, passport).

Liability Release Waiver and Photo Release Form
Liability Waiver

This Personal Injury Waiver (the "Waiver") is made by the undersigned for the purpose of utilizing the facilities and premises managed by Japanese American Service Committee, (hereafter the "JASC"), at the location of JASC, 5700 N Lincoln Ave., Chicago, IL 60659, and in the acknowledgment that in the utilization of the premises and facilities of the JASC, occupies risk of personal injury that may arise or happen at any time. In consideration of the JASC allowing the undersigned to make use of the venue and its facilities and equipment for the relevant purpose by which the JASC allows, the undersigned agrees to assume the foreseeable and unforeseeable risk of personal injuries related to the activity, and agrees to release, discharge, and hold harmless the JASC, its Board of Directors, and employees free from any and all liabilities, claims, cause of action, damages, or losses, which may be incurred by the undersigned in using said premises and its equipment and/or facilities, and which may arise from any reason whatsoever, specifically including, but not limited to, any negligence on the part of the owners, its employees, or losses arising from theft or for any other reason whatsoever. This Waiver shall be binding upon the parties, their respective heirs, representatives, successors, and assigns. In case any part of this Waiver be construed as improper or invalid, such invalidity will affect only that part of this Waiver and the rest shall remain valid and enforceable. Any alteration, modification, or amendment to this Waiver shall not be considered as valid unless otherwise written and signed by the undersigned herein.
I have read and fully understand the above Waiver and Consent form and by typing my name below hereby give my permission and agreement to these documents.
Please type your name above to give your consent.
Photo Release Consent
I hereby authorize Japanese American Service Committee ("JASC") and its representatives to use, print, publish, or display a picture and/or use my name for public relations or other purposes to benefit the JASC and its program. I have read and understand this consent form.

I hereby grant and authorize JASC to make use of photos involving the child/children listed above in this registration form. I understand that I can withdraw my consent at any time.I do not allow the use of photos of the child/children listed above in this registration form.
Authorized Representative's Name

First NameLast Name
Authorized Representative's relationship to child being registered
Relationship
Cancellation Policy
Cancellations made more than 48 hours before the class: Option to transfer to another class, or full refund. Less than 48 hours before the class: Option to reschedule to another class, subject to availability. If rescheduling isn't possible, a 50% refund will be offered. No-show without prior notice: No refund or rescheduling.

I acknowledge the class cancellation policy.

Kids Cooking Classes Registration Form

Cooking classes will be held at:

Student Information

Student #2 Information

Emergency Contact and Pick Up Procedures

Liability Release Waiver and Photo Release Form

Class Selection and Payment