Sports Skills Program Santa Clara Registration 26-27

Please confirm that you are registering for the following program:
Child's Name

First NameLast Name
Child's Date of Birth

MonthDayYear
Date
Child's Gender
Child's Grade Level
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name

First NameLast Name
Mother's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Email
example@example.com
Father's Name

First NameLast Name
Father's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Father's Email
example@example.com
Does your child have any allergies?
Does your child have any medical conditions?
Does your child have any special needs?
Please indicate your child's T-shirt size for the BEAM T-shirt.
Do you have a community code?
Which sport are you interested in?

Media Release Form for Minor Children
BEAM (Building & Enriching American Muslims) has my permission to use my or my child’s photograph publicly to promote BEAM. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensations shall become payable to me by reason of such use.
Assumption of COVID 19 Risk
COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. By signing this Addendum, Parents acknowledge the contagious nature of COVID-19 and voluntarily assume the risks associated with sending their child to BEAM Academy’s in-person programs. Parents voluntarily agree to assume all of the foregoing risks on behalf of their children.
Waiver and Release of Liability
I agree that this Waiver and Release of Liability shall apply to each day I am at BEAM’s rented program facility regardless of the date that this form is signed below. I agree I will assume the risk and full responsibility for any and all injuries, losses, or damages, that might occur to my child or other family members while on the premises where BEAM programs are being held or participating in any off-site activities; and to the maximum extent of the law, I agree to waive and release any and all claims, suits, or related causes of action against BEAM, their owners, officers, employees or agents for injury, loss, death, costs, or other damages to me, my heirs or assigns, or third party claims suits or related causes of action asserted against BEAM programs or activities arising from my conduct and/or family’s conduct while participating in BEAM’S programs and activities. I further agree to release, indemnify, defend and hold BEAM harmless from any liability whatsoever for future claims presented by my child for injuries, losses, or damages.
Payments and Fees
Registration Fee: Non-Refundable $130 per year --- (Required for each child enrolled). BEAM T-shirt Fee: Non-refundable $15. Total Monthly Payments: $60--- I understand that the yearly fee should be paid in full, but for convenience, the tuition can be paid monthly. I agree to pay the monthly fee, due by the first day of each month by automatic credit card payment. Parents or guardians agree and understand that a 30 day written notice of withdrawal must be submitted before the first date of the month that parents or guardians wish to withdraw the child from the program. Notice should be turned in by email to admin@beamacademy.com. If notice is received 30 days prior to the official withdrawal date, auto payment will stop after 30 days of notice. If no notice is received, auto payment will continue till the end of the registration period. No notice implies that your child will return at some point in the program and your spot is being held for your child and can not be offered to anyone. The last month to withdraw from the program is March, so the last day to send a withdrawal notice is February 28. If a notice is received after February 28, it will not be accepted.
Payment Options
prevnext( X )
Skills Program
$15 BEAM T-shirt + $ 135.2 Yearly Registration Fee. Then a total of 9 Monthly Cycles of $62.4 :(1) May+ (8) Aug-Mar

($62.40 for 60 days, then $62.40 for 1 month)
Should be Empty:

Media Release Form for Minor Children

Assumption of COVID 19 Risk

Waiver and Release of Liability

Payments and Fees

Payment Options*

Payment Options