MEMBERSHIP APPLICATION

All guests shall enjoy the revocable and controlled right to use the facility in accordance with the following rules and regulations. 1. All guests must have parents/guardians read all the rules and regulations and complete this form; NO EXCEPTIONS! 2. Guests are not allowed to leave the facility unless escorted by a parent or guardian or other authorized person. When parents arrive to pick up, they must come inside for their youth. If youth is to ride with someone other than their parents or guardians, they must have permission of a parent/guardian before the youth can be released. There will be a $5.00 late charge per child if not picked up by the designated closing time. 3. NO smoking, NO alcoholic beverages, NO drugs, NO fighting or belligerent behavior, NO profanity, NO dirty dances and NO black shoes or gum in the gym. 4. Guests who conduct themselves in an unbecoming manner or become a nuisance to Friday Nite Live!, Communities for Kidz, or other guests may be suspended or expelled from either or both programs. There upon all privileges of such guest shall be automatically terminated without prorating or refund. At that time, the suspended guest will wait in the penalty room, and the parent/guardian will be notified to pick up the youth immediately. 5. Friday Nite Live! and Communities for Kidz reserves the right to refuse admittance or services to anyone. 6. Friday Nite Live! and Communities for Kidz is not responsible or liable for any lost or stolen articles .

APPLICATION (all fields required)

Childs Name: ______________________________________ Gender: ________ Age: ______ Grade: ______ Date of Birth: ____________

School: _____________________________

Parent/Guardian Name: ____________________________ Address: ____________________________ Home Phone: (___)____-_______ Emergency Phone: (___)____-_______

Spouses Name: _____________________ State: ______ Zip: _______

City: _________________

Cell Phone: (___)____-_______ E-Mail: ____________________________________________

Would you like to receive our e-mail newsletter? Yes Please! No Thank You!
RELEASE In consideration of my child being accepted to the Friday Nite Live! and Communities for Kidz Program, I do hereby waive and release Friday Nite Live!, Communities for Kidz, and the Program Facility of all rights and claims for damages and/or injuries sustained by my child in connection with his/her association and participation in the said Program events except for gross negligence on part of Friday Nite Live! and Communities for Kidz. In event I cannot be reached in an emergency, I hereby give permission to Friday Nite Live! to secure proper treatment of my child named above. I also understand I am financially responsible for any willful damage my child might do to the program facility. I hereby give my permission to use my Childs name, photograph, video image and pre-approved quotes in any Friday Nite Live! and Communities for Kidz corporate brochure, newsletters, web sites, or any other promotional media to be distributed free to other participants and prospective participants of Friday Nite Live! and Communities for Kidz youth activity centers. Furthermore, I understand these photographs may be made available publicly, used in local and national newspapers and television, but will not be made available for sale. I have read and understand the rules and regulations listed above. I agree my child is to comply with them fully, and I assume personal responsibility for my child.

Parent /Guardian Signature: ______________________________________ Date: ________________________ (must be signed in person)