1. HIP-HOP & Sign up for Session 2 today for $90!!! Join for
Register & Pay online at
using code AMEZ
(hard copy registrations filled out below are due to instructor if not registering / paying online)
Join for
HIP-HOP
&
Wednesdays 2:15-3:15
@ Addison Mizner
(Grades k-5)
Tear Here
OFF-LINE PARTICIPANT REGISTRATION (Addison Mizner zumba)
Student Name:
Grade:
Gender:
M / F
My Child is:
After-Care / Car Rider* (*see back)
Age:
Birthday:
T-Shirt Size :
S / M / L / XL
Teacher:
MAKE CHECKS PAYABLE TO MIZFIT, INC. - CC INSTRUCTIONS ON REVERSE SIDE
WAIVER & PARENT CONTACT INFORMATION
Signature required before a student can participate:
I hereby release and agree to indemnify and hold harmless: MizFit, Inc., Palm Beach County Schools, Addison Mizner Elementary and all instructors from any liability and against any and all claims resulting from participation in this program, with my knowledge that by participating in this activity my child assumes risk of injury. I also hereby give permission to MizFit, Inc. to use and display any photographs taken of my child, which may be forwarded to newspapers and other publications in which the photograph would be associated with MizFit, Inc.
Parent/Guardian Printed Name:
Date:
Best Phone # for Contact:
Mailing Address including City & Zip:
Parent or Guardian
Signature:
Address:

2. Session 2 dates: 11/1 11/15 11/29 12/6 12/13 12/20 1/10/18 1/17
Ask about
our Summer & Mini camps
visit MizFitInc.com for more info!!!
11/1
11/15
11/29
12/6
12/13
12/20
1/10/18
1/17
Questions? Call (954)
or to
DISTRIBUTION DOES NOT IMPLY ENDORSEMENT OR RECOMMENDATION BY PALM BEACH COUNTY PUBLIC SCHOOLS
MIZFIT, INC. is a licensed and insured Florida corporation
Instructors are CPR and First Aid certified
Program requires a minimum of 10 participants
Tear Here
CC PAYMENTS ACCEPTED AT
using code AMez or
fill out & sign below:
Visa / MasterCard / Amex accepted
This form is REQUIRED to avoid any disputes that might arise, for your protection as the Credit Card Holder, as well as our own protection against possible fraud.
I hereby authorize Mizfit, Inc. and/or it’s assigns, to charge my credit card for services rendered in the amount of
$__________
CC Type (circle one): VISA / MC / AMEX
CC #:
Expiration Date:
CVC Code:
Zip Code:
Name (exactly as
it appears on card):
PRINT
CLEARLY
SIGNATURE:
Today’s Date:
*PICKUP AUTHORIZATION for NON-AFTERCARE Students only
The following people may pick up my child
(ID’s will be required):
Disclaimer
Mizfit, Inc. is not affiliated with or endorsed by the School Board of Palm Beach County or Addison Mizner Elementary and the events/activities hosted by Mizfit Inc. on Addison Mizner Elementary’s premises pursuant to a lease agreement shall not be construed as being conducted, funded, hosted, or sponsored by the School Board or Addison Mizner Elementary on behalf of Mizfit, Inc. The School Board and Addison Mizner Elementary undertake no responsibility for supervising or monitoring Mizfit Inc.’s events/activities and will not be liable for any and all actions of Mizfit Inc. on Addison Mizner Elementary’s premises.