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AFTERSCHOOL REGISTRATION (Parents w/ Credits)

AFTERSCHOOL WINTER/SPRING 2021 REGISTRATION FOR PARENTS WITH CREDITS
First & Last
CURRENT SCHOOL SCHEDULE
Are you registering a sibling?
If you are registering a sibling , make sure to fill out another application for the sibling. You will be directed to payment after each application. Please pay in full and the discount will come out of the following payment.
SCHEDULE (please choose all classes you are registering for):
MONDAYS
WEDNESDAYS
LIABILITY WAIVER (Please Read Carefully)
By initialing the PARENTAL/GUARDIAN SIGNATURE ACKNOWLEDGEMENT AND AGREEMENT box and submitting this form, I agree to the terms and conditions listed above.
ACTIVITY CONSENT FORM AND APPROVAL BY PARENT OR LEGAL GUARDIAN
My Child has approval to participate in ALL WALKING TRIPS INCLUDING ISHAM PARK, INWOOD HILL PARK, NORTH COVE, ETC. Date(s) of outings: 9/2020-12/2020 Departure Site: BREAD AND YOGA's studio or Isham Park. Departure Time: BETWEEN 3:30PM-5:30PM Return Site: Isham Park or Inwood Hill park Return Time: BETWEEN 3:30PM-6PM *
By checking the PARENTAL/GUARDIAN SIGNATURE ACKNOWLEDGEMENT AND AGREEMENT box and submitting this form, I agree to the terms and conditions listed above.
COVID-19 WAIVER: HOLD HARMLESS AGREEMENT
I acknowledge that the novel coronavirus ("COVID-19") infections have been confirmed throughout the United States, including New York City, and understand the hazards associated with COVID-19 and the guidance and protocols issued by federal, state, and local governments and federal and state health agencies for slowing the transmission of COVID-19. I acknowledge the risks associated with COVID-19, and hereby willingly choose to allow my child to participate in one or more of the Bread & Yoga after-school programs. Bread & Yoga has put in place protective measures to reduce the spread of COVID-19; however, Bread & Yoga cannot guarantee that Myself or my child(ren) will not become infected with COVID-19. I fully acknowledge both the known and potential dangers of participating in the program and acknowledge that such participation may, despite Bread & Yoga’s reasonable efforts to mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability, and/or death. I have carefully considered the risk involved and have given consent for my child to participate in the activity. I understand that participation in the activity is entirely voluntary and requires participants to abide by all applicable rules and standards of conduct, including but not limited to all company policies, guidelines, signage and instructions. To prevent the spread of COVID-19 and reduce the potential risk of exposure to all parties, I also understand that I will be required to complete a simple screening questionnaire prior to my child’s arrival each day. I release BREAD AND YOGA, the activity coordinator, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation. In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program activities. *
By checking the PARENTAL/GUARDIAN SIGNATURE ACKNOWLEDGEMENT AND AGREEMENT box and submitting this form, I agree to the terms and conditions listed above.
YOUTH PROGRAMS FOR MINORS MEDIA, PHOTO, & VIDEO RELEASE FORM (Please read the following release carefully and sign below.)
As to any child/children who are enrolled in the after-school program operated by the Studio, I agree that Bread & Yoga (including its staff, employees and agents) can take and use photos, video and audio recordings of the child/children named in this registration for the limited purposes of providing content for the AfterSchool blog and/or marketing the program which may be publicly available on the internet, without compensational obligation, and I hereby release the Studio (including its staff, employees and agents) from any claims resulting from their use of photos, videos and audio recordings (Please note: if you want to understand why we seek your consent for this or to request that we do not publicly use photos, videos and/or audio recordings featuring your child/children, please contact director@breadandyoga.com ). Further, I acknowledge and agree that the child/children and myself and any co-parent or co-guardian, are not allowed to take, and shall not take, any photographs, video, or other recordings of other children or other parents/guardians participating in the programs without their express consent, and are not allowed to transmit, upload, or post such content online or electronically including on any social media or similar site, or use or publish such content in any non-personal media such as a book, video, film, television program or publicly viewable website. Upon the Studio’s request, I agree to delete and/or remove such content from any device, site, platform, or other media, if, in the Studio’s sole and absolute discretion, such content and/or the manner in which it is presented violates the terms of this agreement, is objectionable, inappropriate, or violates the privacy rights or right of publicity of others. *
By checking the PARENTAL/GUARDIAN SIGNATURE ACKNOWLEDGEMENT AND AGREEMENT box and submitting this form, I agree to the terms and conditions listed above.
COPPA NOTIFICATION
Parental Notice Regarding the Children’s Online Privacy Protection Act (“COPPA”) Under the Children’s Online Privacy Protection Act (“COPPA”), we must provide you with direct notice before collecting “personal information” from your child. Effective July 1, 2013, the Federal Trade Commission (“FTC”) updated COPPA to reflect changes in technology, and now considers a photograph, video, or audio file containing a child’s image or voice to be a child’s “personal information.” For more information about COPPA, please visit https://www.consumer.ftc.gov/articles/0031-protecting-your-childs-privacy-online. By participating in an event and/or registering your child for the programs operated by Bread & Yoga, your child will have the opportunity to participate in our various online and/or in-person activities. In some of the activities, your child may participate in online video sessions and/or use online applications to create photo, video, or audio files, projects or software applications that may contain your child’s image or voice as well as the image or voice of other children participating in the program. Once your child has participated in an online session or completed a project, those video or audio files or projects may be shared with participants and their families. Your consent is required for the collection, use, or disclosure of your child’s information as may appear in a photo, video, or audio file, or project(s) or software application that your child creates, collaborates on, participates in, or was included in as part of the after-school activities. Your consent authorizes the collection, use, or disclosure of your child’s information as may appear in a photo, video, or audio file or project(s), or software application to children, parents/guardians of children and staff members of Bread & Yoga as well as to third parties who may receive your child’s information from other children or parents/guardians whose children attend the same online session and/or collaborate on, participate in, or were included in projects with your child. We will not collect, use, or disclose any such information from your child if you do not consent. If you do not provide consent to the collection of your child’s personal information as described above, your child will not be able to register or participate in some activities offered by Bread & Yoga, including the Good News Crew. At any time, you may refuse to permit: 1) your child’s participation in Bread & Yoga (including events, online sessions and/or the after-school activities); 2) further use of your information or your child’s information by Bread & Yoga; or 3) further contact with your child, and request that we delete your information and/or your child’s information. To exercise any of your rights, please email us at director@breadandyoga.com. Your privacy and your child’s privacy are important to us. We do not share any of your information or your child’s information with any third party, except in the limited fashion described above whereby your child participated in an online session and/or collaborated on, participated in, or was included in a project. CHANGES IN THIS COPPA STATEMENT We may change this COPPA Notice. If we decide to change our COPPA notice, YOu will be notified directly. We reserve the right to modify this privacy statement at any time. *
By checking the PARENTAL/GUARDIAN SIGNATURE ACKNOWLEDGEMENT AND AGREEMENT box and submitting this form, I agree to the terms and conditions listed above.
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Note: After clicking SUBMIT below, you will be redirected to a new screen to pay your deposit. Click to select the AfterSchool package you'd like and the corresponding number of classes per week.

Contact

Bread and Yoga
5000 Broadway, Suite A
(Entrance on 212th St.)
New York, NY 10034
212-569-4112
info@breadandyoga.com