7th & 8th Grade Intro to Middle School 101
 
Page 1 of 1
 
 7th & Grade Intro to Middle School 101 - At Revere 

 
1.
*
 
   
2.
*
 
   
3.
*
ex: xxx-xxx-xxxx
 
   
4.
*
ex: xxx-xxx-xxxx
 
   
5.
*
 
   
6.
*
 
   
7.
*
 
   
8.
We will do our best to honor all group requests.
 

 
   

 
9.
*
Registration is open until all classes are full. We will do our best to accommodate everyone, but due to limited space, we will process forms in the order they are received.
 
  
  
   
10.
 

   
11.
*
Make checks payable to P.E.P. and mail to: P.E.P. - Intro to Middle School 101, 19360 Rinaldi St., #690, Porter Ranch, CA 91326)
 
*
Make checks payable to P.E.P. and mail to: P.E.P. - Intro to Middle School 101, 19360 Rinaldi St., #690, Porter Ranch, CA 91326)



    
   

 
  ***Registration is open until all classes are full. We will do our best to accommodate everyone, but due to limited space, we will process forms in the order they are received.***
   
  Release and Medical Consent Agreement: Although we will provide the utmost quality of care and supervision to insure the safety of our students, accidents can happen. I, the undersigned, as parent or legal guardian of above mentioned student in authorizing participation in this summer program, hereby voluntarily and knowingly execute this release with the express intention to hold harmless Blast Camp, its officers, employees, agents, and affiliates from any and all claims, actions, demands or rights to any and all monetary judgment whatsoever arising from any and all injury or physical harm which may occur to the student participant, especially relating directly or indirectly to any act or omission of perceived negligence resulting in injury or loss of life when participating in any activities associated with Blast Camp, regardless of predisposed medical conditions. In the event of an emergency, I give Blast Camp and its staff and designees the right to provide emergency medical care at their discretion in case the legal guardian or I, the parent, cannot be contacted. 

I have read, understand, and expressly agree to the above statements. By the execution hereof I do further bind myself, my child or legal ward and all heirs, executioners, administrators, or assigns of the same. 

   
12.
 
   
13.
*
Enter your electronic signature
 
   
14.
 
   
  Please email PEPSummerProgram@gmail.com with questions. You will receive an email confirmation once the registration is processed.
   
 
 
 
 Done