ExerSHINE Kids Bootcamp @ Skills on the Hill

ExerSHINE Kids Power Bootcamp @ Skills on the Hill
Parent Name*

First NameLast Name
Child #1 Name*

First NameLast Name
Child #1 DOB (must be between 8 and 12 )

MonthDayYear
Date
Child #2 Name

First NameLast Name
Child #2 DOB (must be between 8 and 12 )

MonthDayYear
Date
Address*

Street Address

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CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
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Are you an active client of Skills on the Hill?*

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How did you hear about us/ExerSHINE Power Bootcamp?*

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Agreement & Release of Liability
I hereby give my permission for my child to participate in a EXERSHINEkids Bootcamp Program run by Skills on the Hill, LLC. I waive and release all rights for any claims against Skills on the Hill, LLC, including any damages and/or injuries that may occur to my child while participating in a EXERSHINEkids Bootcamp class.
Signature

Clear
I certify that my child is in good physical health to participate in a EXERSHINEkids Bootcamp, and I will remain on the premises (or designate another adult to assume responsibility for my child) during the class to support my child as needed.
Signature

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I understand that this group is best suited for children who can participate safely and independently in a small group setting with minimal support. I also understand that instruction is provided for exercises and techniques, but 1:1 assistance is not available and the program is not appropriate for children who have significant attentional or self-regulation challenges or who are at risk for eloping. I certify my child is an appropriate fit for this program to the best of knowledge.
Signature

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I understand that it is my obligation to inform Skills on the Hill of any change in my child’s (or childrens') health/medical status that I am aware of that might impact my child’s (or children's) safety or the safety of someone else while engaging in ExerSHINEkids Power Bootcamp at Skills on the Hill, LLC.
Signature

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Illness Policy

Please do not bring a sick child to ExerSHINEkids Power Bootcamp. No child who presents with or who has experienced any of the following indicators in the last 24 hours will be permitted into the clinic: fever of 100.4°F or above, sore throat, diarrhea, vomiting, any rash that could be contagious, lice, severe cough different from baseline. child does not attend for any other reason, no credit will be given. The family pays for the whole session reservation, regardless of attendance. Please note that ONE makeup session will be offered at the session's conclusion.
Parent signature*

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ExerSHINEkids Power Bootcamp Fee
$600 for 10 weeks per child
*
prevnext( X )
Number of children
$600.00 Child

Total

$0.00
Session dates: Thursdays Oct. 30 – Jan. 22 (10 sessions; no class 11/27, 12/25, 1/1)
Session time: 5:00pm-5:45pm
Location: Skills on the Hill 2301 Columbia Pike, Suite 125, Arlington, VA 22204
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ExerSHINE Kids Power Bootcamp @ Skills on the Hill

Agreement & Release of Liability

Illness Policy

ExerSHINEkids Power Bootcamp Fee

$600 for 10 weeks per child

Session dates: Thursdays Oct. 30 – Jan. 22 (10 sessions; no class 11/27, 12/25, 1/1)

Session time: 5:00pm-5:45pm

Location: Skills on the Hill 2301 Columbia Pike, Suite 125, Arlington, VA 22204