Hardwood Palace
HOMESCHOOL PROGRAM REGISTRATION FORM
Participant's Name: *
Participant's Grade: *
Participant's Age: *
Parent/Guardian's Name:
Parent/ Guardian's Cell: *
Address: *
City: *
State, Zip Code: * *
Phone: *
Cell: *
Email: *
Secondary Contact: *
Secondary Contact's Cell: *
Charter School:
Supervising Teacher (ST):
ST Phone:
ST Email:
CLASS CHOICE:
MONDAYS:
9:00-9:50 AM - $150 - Basketball (4-6th)
10:00-10:50 AM $150 - Improv Theater (6-8th)
10:00-10:50 AM $150 - PE Fun (1-3rd)
10:00-10:50 AM $150 - Basketball (8-12th)
TUESDAYS:
10-11:30AM $250+$25 materials - Persuasive Writing (9-12th)
1:00-1:50 PM $150 - Basketball (7-9th)
1:00-2:15 PM $175 - Children's Theater (4-5th)
1:00-1:50 PM $150 - Volleyball (7-9th)
2:00-2:50PM $150 - Volleyball (10-12th)
WEDNESDAYS:
11:00-11:50 PM $150 - Basketball (4-5th)
THURSDAYS:
9:00-11:00 AM $250 + $25 mat. & $60 prod. fee - Shakespeare Conquest (6-12th)
9:00-9:50 AM $150 - Basketball (4-6th)
1:30-2:20 PM $150 - PE Fun (K-1st)
2:30-3:20 PM $150 - PE Fun (2-3rd)
2:30-3:20 PM $150 - Basketball (4-6th )
2:30-3:20 PM $150 - Volleyball (4-6th )
3:30-4:20 PM $150 - Basketball (7-9th )
3:30-4:20 PM $150 - Volleyball (7-9th)
FRIDAYS:
10:00-11:30 AM $175 Children's Theater (1-3rd)
11:00-11:50 PM $150 - Improv Theater (8-12th)
1:30-2:20 PM $150 - Basketball (9-12th)
1:30-2:20 PM $150 - Volleyball (9-12th)
AGREEMENT, WAIVER & RELEASE:
I AGREE: I UNDERDERSTAND THAT REGISTRATION IS NOT COMPLETE UNTIL A CONFIRMATION EMAIL IS RECEIVED FROM A SUPERVISING TEACHER AT SHARON@HARDWOODPALACE.COM.
I AGREE: I, the parent/guardian/ participant, in registering with Hardwood Palace, understand that he/she/I in attending the events for Hardwood Palace and using the facilities does so at his/her/my own risk. I acknowledge that I am aware of the risks inherent in participating in basketball; both practice and competition; that basketball is a physical sport which can require, considerable running and physical exertion; and could potentially lead to bodily harm or limb injuries. Participants and parents assume full responsibility for all injuries and damages which may occur in or at any of Hardwood Palace events. He/she/I do or does hereby fully and forever release, discharge and hold harmless Hardwood Palace, organizers, employees, sponsors, and agents from any and all claims, demands, damages, rights of action, property loss, present or future resulting from or arising out of any person's participation. In addition, he/she/I agree(s) to follow rules of play and conduct set by Hardwood Palace. He/she/I understand(s) that failure to do so my result in suspension from participation.
MEDIA RELEASE:
I AGREE:

Occasionally the Hardwood Palace staff will take pictures for marketing purposes to post on the website, in brochures, flyers or other media.

I give permission for Hardwood Palace to photograph or videotape my child for the sole purpose of promoting Hardwood Palace's events and activities.

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