Club Sign Me Up 2021-2022

Club Sign Me Up 2021-2022

I would like to register my child (children) for Club Sign Me Up. Please submit a form for each child you wish to register.
I want my child to attend:

virtually an existing onsite club at my child's school
If you chose an existing onsite club, which school hosts your club?
Student Name

First Name Last Name
Parent Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area Code Phone Number
Grade
Teacher
School
Media Release

I, the undersigned, do hereby consent and agree that Bridges for the Deaf and Hard of Hearing, its employees, or agents have the right to take photographs, videotape, or digital recordings of me and/or my children and to use these in any and all media, now or hereafter known, and exclusively for use in

fundraising, public relations and community outreach efforts. I further consent that my name (or my child’s) and identity may be revealed therein or by descriptive text or commentary.

I waive any rights, claims, or interest I may have to control the use of my identity (or my child’s) or likeness in whatever media used.

I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.

I also understand that Bridges for the Deaf and Hard of Hearing is not responsible for any expense or liability incurred as a result of my (or my child’s) participation in this recording, including medical expenses due to any sickness or injury incurred as a result.

I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.
Media Release | Signature

Clear
By your signature, you agree your child will participate in the full year of Club Sign Me Up. You may pay for the entire year at once or by the semester. If only paying by the semester, please provide your credit card information in the space provided below. Thank you!
Commitment to Participate | Signature

Clear
Date

Month Day Year
Date
Notes or Questions?
My Products
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Full Year $ 225.00

Monthly $ 25.00
Please note, if you choose the monthly option, BridgesTN staff will contact you to set up a monthly invoicing plan with you.

Total $ 0.00
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