atam registration form

Please fill out the registration form below

Parent Name *
Parent Name
Student Name *
Student Name
Home Street Address *
Home Street Address
Home Phone *
Home Phone
Cell Phone *
Cell Phone
Emergency Contact Form
Child's Name *
Child's Name
M or F *
Date of Birth *
Date of Birth
Primary Guardianʼs Information
Primary Guardian *
Primary Guardian
Cell Phone *
Cell Phone
Home Phone *
Home Phone
Physical Address
Physical Address
Mailing Address
Mailing Address
Employer Phone #
Employer Phone #
Best way to reach you while child is at our program
– we will do everything we can to reach you. If we cannot reach you, then we will contact the following.
Cell Phone # *
Cell Phone #
Home # *
Home #
Waiver and Release of Liability; Indemnification and Hold Harmless Agreement
In exchange for student’s participation at ATAM, Camper/Student, Parent(s) and/or Legal Guardian(s) of minor campers/students agree to the following:
1. Acknowledgement of Risk. Camper/Student , Parent(s) and/or Legal Guardian(s) acknowledge and fully understand that there are inherent risks of serious injury or death associated with hiking, swimming, playing oudoors, learning indoors and other activities associated with the camp experience. These inherent risks include, but are not limited to: encountering natural dangers such as falling rocks or objects, irregular or uneven ground, unseen and unmarked objects, drowning or serious injury in and around water could occur due to water movement, subsurface conditions, cold water temperature, water impurities and the like. Inherent risks also include acts or omissions of others, the condition of equipment or property, even if properly maintained, electic shock, burns; weather conditions (such as lightening strikes, sunburn, rain or hail storms, tornadoes and the like), contact with plants, animals or insects, the risk of Camper/student engaging in unauthorized activities, Camper’s/student's physical conditions or Camper’s/student's own acts and omissions, conditions or roads, trails, waterways or terrain, the administration and availability of first aid and emergency treatment and consumption of food or drink by Camper/student. Camper/student, Parent(s) and/or Legal Guardian(s) further acknowledge that all inherent risks associated with activities at Art of Technology and Music, including hiking, swimming, water play, working with technology and electricity, riding scooter, surfing and other activities associated with the camp, ATAM or learning experience cannot be described as part of this document.
2. Camper Waiver of Rights and Release of Liability. Camper/ Student, Parent(s) and/or Legal Guardian(s) hereby release, waive and discharge ATAM Art of Technology and Music, Anthony Wamble, Mary Wamble its employees and agents from all liability claims and demands of negligence on the part of any and all ATAM activities its employees and agents arising in connection with the participation in ATAM activities or lessons and use of ATAM facilities and equipment, including, but not limited to, those risks described in paragraph #1 above.
3. Indemnification and hold harmless. Camper/ student, Parent(s) and/or Legal Guardian(s) further agree to indemnify and hold harmless ATAM, Anthony Wamble, Mary Wamble its employees and agents, against all losses, damages, monetary awards and expenses, including all costs and attorneys fees incurred in connection with any and all claims of negligence on the part of ATAM, its employees and agents, brought by Camper/student, Parent(s) and/or Legal Guardian(s), his or her heirs, successors, assigned and legal representatives for any injury, death, illness, disease or damage to property, arising from or connected with participation in any activity of ATAM.
4. Miscellaneous. The parties agree that the provisions of this “Waiver and Release of Liability; Indemnification and Hold Harmless Agreement” (“Agreement”) shall be deemed severable and that the invalidity or unenforceability of any one or more of the provisions of clauses hereof shall not affect the validity or enforceability of the other provisions or clauses hereof except as specifically set forth herein. The terms of this Agreement constitute the entire agreement and understanding between the parties. This Agreement is made pursuant to and shall be construed under the laws of the State of California.
5. Opportunity to Negotiate. You are encouraged to carefully review the contents of this Agreement and take the time you feel necessary to review it. DO NOT SIGN THIS AGREEMENT UNLESS YOU UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS OF THIS AGREEMENT.
6. Permission to Use Images. By participating in or attending any activity in connection with ATAM, I consent to the use of any photographs, pictures, film or videotape taken of me or provided by me for publicity, promotion, television, websites or any other use, and expressly waive any right of privacy, compensation, copyright or other ownership right connected to same.
I CERTIFY THAT I HAVE READ THIS AGREEMENT AND THAT I UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS AND ASSUMING SUBSTANTIAL RESPONSIBILITIES BY SIGNING IT, AND THAT I SIGN IT VOLUNTARILY.
By typing your name you are signing your digital signature
Date *
Date
By typing your name you are signing your digital signature
Date *
Date
User Agreement
By clicking agree, I agree to the terms and conditions listed.
CREDIT CARD ON FILE
Enter the expiration date located on the front or back of card
CARDHOLDER NAME *
CARDHOLDER NAME
CARDHOLDER ADDRESS *
CARDHOLDER ADDRESS
I authorize charges to be made on the first lesson of the month, the quarter or the semester. I have read and I understand ATAM’s Payment and Cancellation Policy. The student will respect the equipment provided at ATAM. If not, then I understand that there is a “you break it, you buy it policy”.
Date
Date
Phone *
Phone