Volleyball Clinic Registration Form
Clinic provided by Daniella Miranda-Johnson at Le Jardin Academy.
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Student's First Name: *
Student's Last Name: *
Grade: *
Contact Information:
Parent/Guardian Name: *
Email: *
Cell #: *
Preferred contact method *
Consent and assumption of risk:
By clicking "yes" below, I hereby waive all responsibilities from Daniella Miranda-Johnson and any employee or volunteer acting with the permission of Daniella Miranda-Johnson from all liabilities arising from property damage and bodily injury which may be sustained during participation in programs at Le Jardin Academy. *
Required
Signature:
Parent/Guardian Name:
Date: *
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