Child Name
Home Phone:
Date of Birth
Parent(s) Guardian (S) Name
Cell Phone:
Work Phone:
Emergency contact name
Emergency contact phone
                                                              Policies Waiver
 - TUITION  Tuition is due the start of the 1st session.  Tuition is non refundable.  No refunds are given for classes missed.  A $35 NSF fee will be charged on all returned checks.  I understand and agree my credit card will be charged on the 11th of the month for balances due on my account.
 - PHOTO RELEASE OT GrindTime requests your permission to take photos and videos of your children to possibly use on our website, Facebook, and/or marketing materials.
 - CANCELLATION  Minimum of 2 week’s notice of cancellation must be provided via email to
                                                              Participation Waiver
I authorize the verification of the information provided on this form and have read and understand the above policies of OT GrindTime. 

As parent and/or legal guardian of the participant(s) I agree to the following:
- I am aware that the child/children listed will be engaging in physical exercise involving various sports, coordination events, and general fitness training that can cause harm or injury.
- I understand that the child/children listed are voluntarily participating in the program activities and I am assuming all risks of injury to my child/children that may result from engaging in exercise program or sport related event.
- I hereby agree to waive any claims or rights that I may otherwise have to sue OT GrindTime or OT GrindTime owners, employees for any injury that might occur.
- I understand that OT GrindTime will make no evaluations or recommendation as to whether or not the child/children listed is capable or deemed physically fit to engage in any activity.
- If the child/children listed has any physical or mental condition that may impair their ability to engage in any OT GrindTime activities it is MY responsibility to obtain a physician’s release.
- I understand that it is recommended I consult a physician prior to my child’s/children’s participation in any physical exercise program.