Cra-Z-Dreams Registration Form

Cra-Z-Dreams Jr. Registration Form

(ages 5 to 17)

Cra-Z-Dreams Life Skills Development LLC
Child Information
Name *

First Name Last Name
Age *
Grade *
School Attending *
Guardian / Parents Names *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Cell Phone *

Area Code Phone Number
Secondary Phone

Area Code Phone Number
E-mail *

**Pay by Debit or Credit Online** My Products (Platinum customers enter # sessions > 10 next to "Quantity")

Platinum Package (10+ sessions) $ 175.00

Platinum Additional Sessions (# extra sessions above 10) $ 17.50

Quantity
Item subtotal: $ 0.00

Gold Package (8 sessions) $ 160.00

Silver Package (6 sessions) $ 135.00

Bronze Package (4 sessions) $ 100.00

TW-Group (10+ people) 2-day Workshop + WFLCS + t-shirt $ 85.00

TW-Group (10+ people) 1-day Workshop + WFLCS $ 50.00

Cra-Z-Dreams Hosted 2-day Workshop + WFLCS + t-shirt $ 125.00

Cra-Z-Dreams Hosted 1-day Workshop + WFLCS $ 75.00

Individual Life Coaching Session (per hour) $ 100.00

Enter coupon

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

Desired Package - Pay by Phone (enter # sessions > 10 or discount codes under "Other"). Cra-Z-Dreams will contact you to confirm your order and process payment:

Platinum (10+ sessions) ---> $175+ Gold (8 sessions) ---> $160 Silver (6 sessions) ---> $135 Bronze (4 sessions) ---> $100 Platinum Additional Sessions (# sessions > 10) ---> $17.50 One Day Intro Workshop (2 hours) ---> $50.00
Please choose your child's program(s) below. Scheduling/availability for one-on-one mentorship, basketball or tennis training should be arranged with the program coordinator prior to purchasing. Please do not exceed the number of sessions included in your package. *

Creative Expressions: Word Warriors (Ages 11-17. Every 3rd Saturday 2-4pm) Girls' L.Y.F. : Love Yourself First! (Girls 11-17. Every 3rd Saturday 2-4pm) Boys' L.Y.F. : Building Men from the Inside Out (Boys 11-17. Every 4th Saturday 2-4pm) G.R.E.A.T. S.T.A.R.T. 2-day Crash Course (Ages 11-17. Two 3 hour workshops.) DestinMe Purpose/Career Planning (Ages 11-17. One 2 hour workshop.) Life-onomics: Making Dollar Decisions (Ages 11-17. One 2 hour workshop.) Vision 4 Life Vision Board (Ages 11-17. One 2 hour workshop.) Social Media Management (Ages 11-17. One 2 hour workshop.) Professional Skills (Ages 11-17. One 2 hour workshop.) Individual Life Coaching Session (Ages 11-17. Contact Director to schedule desired # of sessions.) Basketball (Ages 5-17. Contact Director to schedule desired # of sessions.) Tennis (Ages 5-17. Contact Director to schedule desired # of sessions.)
Please enter any growth areas that should be points of focus for your child along with his/her strengths. If you registered for sports training please include experience, skill level and sports development information. (Send an email to info@cra-z-dreams.com with child's name if you run out of space)
Interested in Volunteering?

Class Assistant Assistant Coach Team Mom P.E.E.R. Leader Club
One-on-one Mentorship or Sports Training Start Date (Availability TBD)

Month Day Year

SPORTS REGISTRANTS: My child would like to train or play on the same team with following players. Organizers will attempt to take these requests into consideration along with your skill level when forming teams and/or training groups.
Important Notes

· Dress appropriately (school appropriate attire -- see our guide).

· Keep the classroom/practice area/facility clean.

· Be courteous and respectful to everyone we encounter.

. No food or drinks in classroom/gym, but those might be sold outside of the classroom/gym for participants and others.

· Sports team/training organizers reserve the right to form the teams and/or training groups to ensure maximum benefit and growth of each player/participant.

· Fee: See pricing list/quote (provided separately).

. All members and parents are expected to demonstrate proper respect to teachers, coaches, special guests and other members/students. Cra-Z-Dreams reserves the right to release any member(s) for conduct by him/her or their parent(s) deemed inappropriate or detrimental to the program WITH NO REFUND. We are here to develop character and life skills for each child and maximize the growth of each individual.
Emergency Contact & Health Insurance Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Does the child you are registering have health insurance?

Yes No
Insurance Carrier
Name of Policy Holder
Subscriber ID
Group Number
Card Number / Card Date
Does the participating child have any allergies, chronic illness, or medical conditions? *

Yes No
Please describe *
Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.
Name of Physician / Emergency Medical Care Facility
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Release of Liability

Although the safety of all sport activities is the primary concern, indoor and outdoor sport activities with the VIPERS program may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against Cra-Z-Dreams Life Skills Development LLC and the persons in charge.
I have read and agree to the above conditions

Yes No I am not registering for sports (a separate waiver will be provided with the Cra-Z-Dreams policies/handbook)
Parent/Guardian's Signature *
Relationship to Child *
Should be Empty:

Release of Liability