2012 13 Registration by i301aw

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									Weekly Class Registration
STUDENT INFORMATION

                                                            Check here if returning student and
  Students Name:
                                                        proceed to Package Options

  Date of Birth:                                        Age:

  Parent’s Name:                                        Email:

  Street Address:                                       City/State/Zip:

  Primary Phone:                                        Secondary Phone:

  Emergency Contact:
                                                        Phone:
  (other than parent listed above)

  Known Allergies/Concerns:


PACKAGE OPTIONS

           Monthly Membership ($79/month + one-time $49 registration fee)
              3-month minimum, checking or credit card authorization required
              *if you choose to pay other than automatic deduction there is a $10 fee each month
           4 week Fun Pack $100
           Single Class $30
           Sunday Monthly Class $50

       ♦ Please Indicate Any Special Offers or Discounts:
       ♦ Student’s Start Date:


CLASS OPTIONS

       Kindercooks (ages 3-6)                           Pastry Class
           Saturdays 10:00 AM-11:30 AM                      Thursdays 6:00-7:30 PM (ages 9+)
           Thursdays 4:00 PM-5:30 PM
                                                        Teens
       Jr. Chefs (ages 5-12)                                Wednesday 6:30-8:00 PM (ages 12+)
           Mondays 6:00-7:30 PM (ages 9-12)
           Tuesdays 6:00-7:30 PM (ages 6-12)            MasterChefs-Advanced Jr Chefs (ages 9+)
           Wednesdays 4:30-6:00 PM (ages 5-9)               Thursdays 6:30 PM-8:00 PM By Approval Only
           4th Sunday Class 2:00-5:00 PM (ages 6+)




                        GahannaOh@YoungChefsAcademy.com or, mail to:
       E-mail completed forms to:
 Young Chefs Academy ♦ 425 Beecher Road, Suite E ♦ Gahanna, Ohio 43230
                                  RELEASE OF LIABILITY
The undersigned individual desires to use one or more of the Young Chefs facilities (collectively the “Facility”)
and/or to participate in activities or programs (collectively the “Activities”) sponsored by or involving Young Chefs
International LP, Young Chefs GP LLC, and all franchisees thereof (collectively, "Young Chefs"). In consideration
for Young Chefs permitting me to use the Facility and permitting me to participate in the Activities, I have agreed to
execute this Release of Liability (the “Release”). I acknowledge that using the Facility and participating in the
Activities may involve certain inherent risks, including the risk of personal injury. I agree to assume all such risks, as
well as any other risks involved in using the Facility, participating in the Activities or participating in any other activity
sponsored by or involving Young Chefs. I release and discharge Young Chefs and all of its employees, agents,
representatives, partners, and members, as well as all other persons or entities that may own, operate or manage
each Facility, as well as any and all other persons or entities that might have any liability whatsoever to me related
to the Facility, the Activities, or Young Chefs (collectively, the “Released Parties”), from and against any and all
damages, actions, claims and liabilities, whether known or unknown, anticipated or unanticipated, suspected or
unsuspected, relating to or arising from any activity, occurrence or event involving, related to, or arising out of the
Facility, the Activities, or Young Chefs. This Release is intended to release and discharge the Released Parties
from all damages, actions, claims and liabilities of any nature, specifically including, but not limited to,
damages, actions, claims and liabilities arising from or related to the negligence of the Released Parties. I
further agree to indemnify, hold harmless, and defend Young Chefs and each of the other Released Parties
from and against any loss, damage, liability and expense, including costs and attorneys’ fees, incurred by
Young Chefs or any of the other Released Parties as a result of my using the Facility, participating in the
Activities, or participating in any other activity sponsored by or involving Young Chefs.

Young Chefs reserves the right to use any photograph taken at the Facility, or in connection with any Activities or
other activity involving Young Chefs, including but not limited to those taken during a program, a birthday party, a
group event, or other Activity, to be used in Young Chefs’ promotional materials, brochures and web site.

    THIS RELEASE IS A BINDING LEGAL CONTRACT, PLEASE READ IT CAREFULLY BEFORE SIGNING.


_________________________________________________ __________________________
Signature of Participant                          Date

_________________________________________________
Participant name (please print)



TO BE SIGNED IF PARTICIPANT IS A MINOR
I represent that I am the parent or legal guardian of the above individual and hereby consent to the individual using
the Facility, participating in the Activities, and participating in other activities sponsored by Young Chefs. In
consideration for Young Chefs allowing the above individual to use the Facility, participate in the Activities, and
participate in the other activities, I agree, personally and on behalf of the individual, to be bound by the terms and
conditions of this Release. I further agree to indemnify, hold harmless and defend Young Chefs and all other
Released Parties from and against any loss, damage, liability and expense, including costs and attorneys’
fees, incurred by Young Chefs or the other Released Parties as a result of the above individual using the
Facility, participating in the Activities or participating in any other activity involving Young Chefs.

    THIS RELEASE IS A BINDING LEGAL CONTRACT, PLEASE READ IT CAREFULLY BEFORE SIGNING.

____________________________________________________                               __________________________
Signature of Parent or Court-Appointed Legal Guardian                              Date

____________________________________________________
Printed Name of Parent or Court-Appointed Legal Guardian
                      CREDIT CARD AUTHORIZATION
                               (MONTHLY MEMBERSHIP ONLY)


I (we) hereby authorize Young Chefs Academy, Kulinary Kids hereinafter called YCA, to initiate credit
entries for Chefs Club Membership to my (our) account indicated below and the financial institution
named below, hereinafter called FINANCIAL INSTITUTION, to credit the same to such account. I (we)
acknowledge that the origination of ACH transactions to my (our) account must comply with the
provisions of U.S. law.



   Billing Name:

   Credit Card Number:

   Expiration:

   CVV Code (3 digit code on the back of the card):

   Billing Address:

   Billing Zip Code:



Print Individual Name:                                      Student:


_____________________________________________               Date: __________________
Signature




   Check here to decline the above authorization. I (we) acknowledge by declining electronic
   submission of funds, the I (we) are required to pay an additional $10/Month for a total of $89



Print Individual Name:                                      Student:


_____________________________________________               Date: __________________
Signature

								
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