ONLINE REGISTRATION FORM
Last Name First Name (parent)
Student Name
Date of Birth
Mailing address: , ,
Please note that your payment will be processed by Team Raposa.
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The Cultural Integration and Arts Association (CINA) is a 501c3 nonprofit based in Newark, NJ. CINA will be utilizing Team Raposa for payment processing. I hereby authorize CINA and Team Raposa, LLC to charge my account in the agreed upon amount. I also agree that future incidental fees that are not stated in this form (such as materials or various out-of-school fees) will be charged upon my authorization. I authorize CINA and Team Raposa, LLC to collect a return debit NSF fee of $25 per item by electronic debit from the same account.
I agree to allow the Cultural Integration and Arts Association (CINA) NS Team Raposa, LLC to use photos and videos of my child or myself taken during the lessons, promotion or other events.
I, acknowledge that participating in the chosen course offered at the CINA Cultural Center involves certain risks and responsibilities. In consideration for being allowed to participate in this course, I hereby agree to the following terms and conditions:
The student is aware in making this agreement to participate in classes offered by the Cultural Integration and Arts Association (CINA) at the CINA Cultural Center.
I understand that this language course is conducted in a classroom setting, and I am responsible for ensuring my own safety during class sessions.
I understand that I am expected to attend all classes, be on time, and complete all assignments to the best of my ability.
I understand that the Cultural Integration and Arts Association (CINA), Team Raposa and its instructors are not responsible for any injuries, damages, or losses that I may sustain during the course of this language class.
I hereby release the Cultural Integration and Arts Association (CINA), Team Raposa, and its instructors, and its agents from any and all liability, claims, demands, or causes of action that may arise from my participation in the Cultural Integration and Arts Association (CINA) and Team Raposa course.
I agree to indemnify and hold harmless Cultural Integration and Arts Association (CINA), Team Raposa, its instructors, and its agents from any and all liability, claims, demands, or causes of action arising from my negligent or intentional acts or omissions during the course of this language class.
I understand that Cultural Integration and Arts Association (CINA), Team Raposa reserves the right to dismiss any student from the class for disruptive behavior or failure to comply with the school's policies.
This release shall also include any landlord or leaseholder of any training facility in which training is conducted. I also agree that the terms hereof shall serve as a release and assumption of risk for my heirs, executors and administrators, and for all members of my family, including any minors.
The student attests that he/she is in good physical condition and has no known or suspected medical conditions that would preclude vigorous physical activity.
It is further agreed that the student’s name, photograph or other representation for the purposes of promotion or publicity for this Taekwondo program or the instructor/school may be used.
As part of the consideration for participation, the student acknowledges and assumes all these risks and wishes to enroll in this course of instruction.
I have cleared out the training area of any unsafe items that may obstruct your practice.
It is recommended that participants have a checkup by a physician before beginning any new physical regimen.