Student Information:

Name

First Name

Last Name

DOB

YYYY

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent(s)/Legal Guardian(s) Information:

Mother’s Name

First Name

Last Name

Mother’s Phone

(###)

###

####

Mother’s Email

Father’s Name

First Name

Last Name

Father’s Phone

(###)

###

####

Father’s Email

Release of Liability

I understand that my participation and/or involvement in classes of Ukrainian School of Atlanta carries a potential for certain risks, some of which may not be reasonably foreseeable. I further acknowledge that these risks could cause me, or others around me, including, but not limited to, bodily injury, damage to property, emotional distress, or death. I am a willing participant in classes and activities at Ukrainian School of Atlanta. By signing this agreement, I, the parent/guardian agree to release indemnity and hold harmless Ukrainian School of Atlanta as well as all their employees, instructors, representatives, etc from all losses, claimes, theft, demands, liabilities, causes of action, or expenses, known or unknown, arising out of my participation in classes at the Ukrainian School of Atlanta.

Media Release Authorization Form

I hereby give Ukrainian School of Atlanta the right and permission to publish, use photographs or video, and/or audio recordings of my child, a student enrolled in Ukrainian School of Atlanta. I understand that such reproductions could be used to publicize or promote my child’s school through its own media productions (Website, social media, printed and/or online brochures, promotional videos, etc.) or through the commercial media (television, radio, Internet or print), teacher training, parent conference. I waive any right to inspect and/or approve the finished product and do release Ukrainian School of Atlanta from any liability by virtue of distortion by processing. I further agree that these items may be used for publication, broadcast or reproduction without limitation or reservation or any fee.

Parent/Guardian’s Name:

Date

YYYY

Student Registration & Consent Form 2024 -2025

Ukrainian School of Atlanta