Registration Form
Last Name:
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First Name
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Middle Name:
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Subject (circle your choices): Math, Social Studies, Physical Science, Earth/Life Science, Spanish, Lang.Arts
Grades (circle your choices): 4, 5, 6, 7, 8
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PARENTS OR GUARDIANS
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(1) Last Name:
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First Name:
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Relationship to Child:
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Address:
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City:
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Postal Code:
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Home Phone:
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Cell Phone
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Please Read and Sign
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This is a holy place. Please treat as such and abide by rules of the temple at all times. People who are not complying by the rules will be asked to leave temple premises.
Parent/Guardian Signature Date
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NASSTA Disclaimer Form
I/We hereby give our consent for the above student(s) to participate in NASSTA activities. I/We also give my/our consent for him/her/them to participate in school activities and will not hold NASSTA responsible in case of an accident or injury We hereby agree to hold NASSTA, its staff, and volunteers harmless from any and all liabilities, actions, causes of action, debts, claims, demands of every kind and nature including losses of any kind whatsoever that may arise by or in connection with the participation by my/our child/children in any activities related to NASSTA program.
Furthermore, it is parent’s (s) responsibility to arrange for bringing and picking up the student(s) to the NASSTA. The NASSTA assumes no responsibility of Child after the class session is over.
Name: _____________________________________________________________________
Address: ___________________________________________________________________
__________________________________________________________________
Phone Number:______________________________________________________________
Child’s Name:________________________________________________________________
__________________________________________________________________
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Note: Parents are held responsible for the safety of participants and will promote safety of others too.
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Parent/Guardian Signature Date
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