2017 Premier Learning Cooking Club Forms

Come, join in and learn about math, science, language arts and social studies in our cooking club.

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Chefsville Kids: Premier Learning Center

Cooking Club
Letter of Permission and Consent

I would like my child to participate in the 10-week Cooking Club Program.

Club meetings are on Tuesdays from 3:30pm – 4:30pm on:

3/21, 3/28, 4/04, 4/11, 4/18, 4/25, 5/02, 5/09, 5/16, & 5/23


10-week after-school Cooking Club $155 + $5 online fee

Payment options: Full payment or  2 payments spaced 4 weeks apart. Additional online fee if making 2 payments.

Sensitive program health and nutrition topics: This program educates about high blood pressure, diabetes, heart disease and high cholesterol. Discussion points include the medical industry, prescriptions, how foods help in the lowering health risks, and other medical current events. Students will learn about digestion and their senses. Parents who are sensitive about these issues need to advise Chef Scott immediately, as there are no refunds if parents or students are sensitive about these topics. Younger students may only pick up part of this information. There are no refunds allowed if parents decide to withdraw their child from the program without advising of any sensitivity to these topics.

Gathering Health Information on Participant: During the course of participating in Chefsville Kids™ programming, personal health information about my child may be collected as permitted for the purposes of (a) Identifying known food allergies, intolerances, dietary restrictions, medical conditions and contact information for the family doctor, should it be necessary; and (b) planning, monitoring and evaluating this program. I consent to the collection, use, and sharing of personal health information about my child by the staff and volunteers of Chefsville and the entity that hosts such programming. I understand that statistics about this program may be included in annual reports to the community published by Public Health Services, as required or permitted by law. I acknowledge that I have read and understand this consent, and that I may withhold my consent or withdraw my consent at any time by providing written notice.

Media pictures and videos release: I further give consent allowing myself and/or my child(ren) being in pictures and videos used to promote this program without pay to me. The pictures or videos may be taken and used without my knowledge and without payment to me or my heirs, and current or future representatives.

Liability Waiver and Release: I also waive any claim against Chefsville, their agents, servants, insurers and employees, and hereby release them from any claim, cause of action or demand I may have arising out of or in connection with any personal injury or bodily injury, death or property damage which I, my child, my children, those children under my care and direction, may sustain during the Program. The Program, not licensed by Texas, may meet in a Licensed or an exempt facility. Cooking in nature can be a dangerous activity. This indemnification shall include, but not be limited to liability settlements, damage awards, costs, and attorney’s fees associated with any such claims.  By my signature on this Liability Waiver, I bind my heirs, and current or future representatives, and myself to the terms and conditions of this Liability Waiver.

Cancellation prior to program start date shall be refunded less $75. No refunds after program starts.