The text of the form is provided below for reference. Use the button below to download, print, and sign the form.

NOTE: The registration and authorization forms are general 31Bricks Program forms and only need to be filled out by new participants or if/when participant information has changed.

31BRICKS BRICK BUILDER AUTHORIZATION FORM


​31Bricks strives at all times to provide fun and safe brick building activities for all children participating in our programs. To fulfill this commitment, we ask that all children enrolled adhere to basic behavioral guidelines. Our brick techs set clear boundaries and expectations as to appropriate conduct and we will hold all builders to these expectations. We ask your cooperation should any parent be notified of discipline problems. It is our intention to provide children with, not deprive them of, exciting and fun building experiences. It is only when a builder (child) interrupts this positive learning environment that we would take any such action. If necessary, 31Bricks may ask that your child be removed from the program. In such a case, any refund would be at the sole discretion of 31Bricks. 
31Bricks also has expectations of the parents whose children are enrolled. Only children with a sincere interest in our programs to explore creative expression, STEM principles, social interaction and teamwork of a large group of builders should be allowed to enroll. Parents are welcome to observe any class and to participate where appropriate.
 
Please read carefully and sign below:
  • I am the parent or legal guardian of the below named child (builder).
  • I understand that failure to abide by the policies and guidelines as outlined by my child’s brick tech may result in the revocation of my child’s enrollment and forfeiture of any and all registration fees or other funds. Further, I understand that damage to the equipment and/or facility due to reckless acts and or deliberate indifference by my child will be my financial responsibility.
  • I certify that my child is physically able to participate in all 31Bricks activities; or may need some accommodations that I am willing to disclose and will be available to assist my child if necessary.
  • In the event that I cannot be contacted, I hereby authorize 31Bricks and its employees and or representatives and any medical personnel, hospital, and/or physician to give any medical attention to my child.
  • I understand that 31Bricks is not responsible for my child before or after the stated camp times. I understand that 31Bricks reserves the right to charge a late pickup fee of $5.oo per child for each 15 minute interval or portion thereof, beginning 10 minutes after the stated end time of the program. I agree to pay this fee immediately to the 31Bricks Brick Tech should such a charge be required. I understand that my child will not be allowed to return to the program until such fee is paid in full.
  • I hereby release and agree to indemnify and hold harmless 31Bricks, its principals, officers, employees, agents, and representatives, from any and all claims of any nature; which I, my heirs, representatives, executors, administrations, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization; for injury or loss that may result from such participation, preparation for such participation, or spectatorship of any and all activities and preparations.
  • I agree that 31Bricks assumes no responsibility for injuries or losses caused by situations or inappropriate behavior beyond its control.
  • 31Bricks will only release children to the parent /guardian or those individuals listed on the registration form as authorized to pick up. A picture ID is required. If a parent is listed as unauthorized to pick up on the registration form, legal documentation must be provided.
  • I fully consent to allow 31Bricks, its principals, officers, employees, agents and representatives to use any media, including but not limited to film and electronic photography or video, taken during this program for any and all purposes to include publicity and marketing. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my child’s likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.
 
With my full knowledge and consent, I expressly give my child permission to attend this program. 

Child’s full name (please print:                                                                                                    

Date:                                                                       

 
I am the Parent or Legal Guardian/Full name (please print):                                                                                                                                      
 
Signature of Parent or Legal Guardian:                                                                                                                                                                            
Please feel free to include any additional information about your child on reverse side that you feel we should know or would help make this a positive experience for your child.