After School Registration 2023/2024

226 Waverley Road, Dartmouth NS B2X 2C4
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Registrant Fee: $0.00

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Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*GRASSHOPPERS 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

Applicant Signature
Please enter your full name in the space below.

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Registration inquiries:
Master Phil Power
(902) 455-4853
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Parent Information
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(should we be unable to contact either parent, we require an emergency contact person)
Medical Information
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After School Registration Contract 2023/2024 School Year
Legal Disclosure and Contract.

I agree that once i have paid my registration fee that there are are no refunds or transfers.

I am signing up my child(ren) for the ENTIRE 2023/2024 school year. Should I wish to cancel this agreement it can only be done so with written consent of both parties and a 3 month penalty will be billed.

All associated program costs must be paid in advance of service rendered. All payments will be debited through automatic withdrawal and I agree that the amount selected will be debited until the contract ends in June of 2024. Any late payments or arrears will also be automatically debited from my account.

I have read and fully understand the terms and conditions set out by Grasshoppers After School Program. This includes but is not limited to this contract, medical release, Parents handbook, pricing schedule, and pre authorized debit information.

I agree, on behalf of the above named child, his/her heirs and representative to fully and forever release, and hold harmless Grasshoppers Holdings Limited. The After School Program, its agents, servants, and employees from any and all claims, demands, rights of action of causes of action, present or future, whether the same be known, anticipated or unanticipated, resulting from or arising out of transportation, participation or enrolment in this program.

A qualified Instructor, Assistant Instructor, or Junior Instructor conducts all classes. All curriculum and techniques are supervised, but sometimes are more difficult for certain individuals. Please consult your doctor before starting any classes. After consulting your physician, if at any time you feel shortness of breath, pain, or discomfort, please feel free to step out of class and consult an instructor or physician. Grasshoppers Afters School Program can not be held legally responsible for any misuse, negligence, or injury that may result from transportation, instruction or participation at Grasshoppers After School Program.

By signing this I understand and agree with all the terms and conditions set forth by Grasshoppers After School Program for the 2023/2024 school year.
Check this box to indicate that you have read and agree to all of the above terms & conditions