JAM CITY Student Registration & Waiver

1. Student Information

Student Full Name *

Date of Birth *

School Name *

School Level *

Current Grade *

Student Phone

Home Address *

2. High School ID Requirement

HIGH SCHOOL STUDENTS ONLY: A current high school ID is required for entry. No high school ID = no entry. Middle school students are not required to present a school ID under this policy.

High School Name

Student Name as Shown on ID

3. Parent/Guardian Information

Full Legal Name *

Relationship to Student *

Date of Birth *

Phone *

Alternate Phone

Email *

Address *

4. Parent/Guardian ID Verification

ID Type *

State/Country Issued *

Last 4 Digits of ID/DL # *

Expiration Date *

For privacy, this form collects only the last 4 characters of the ID number. JAM CITY may verify the physical ID at check-in.

5. Emergency Contact

Name *

Relationship *

Primary Phone *

Secondary Phone

Allergies / Emergency Medical Information (optional)

6. Authorized Pickup

Pickup Person #1 Name *

Relationship *

Phone *

Pickup Person #2 Name

Relationship

Phone

7. Student Driver Authorization

YES — I authorize my student to drive themselves to and from JAM CITY.

NO — My student will be dropped off and picked up by an authorized adult.

Vehicle Year

Make

Model

Color

License Plate #

Plate State

8. Entry Rules & Zero-Tolerance Policies

Entry rules: No hoodies • Clear bags only • No ski masks / “Pooh Shiesty” masks • High school ID required for high school students.

No weapons of any kind
No fighting
No alcohol or illegal drugs
No cigarettes, vaping, or tobacco
No threats, bullying, intimidation, or harassment
No inappropriate sexual behavior or unwanted touching
No stealing or intentional property damage
No parking-lot loitering
No unauthorized re-entry
Respect staff, security, and other guests
Follow reasonable staff/security instructions

I have reviewed these rules with my student and understand violations may result in removal, parent notification, suspension, permanent ban, or emergency/law-enforcement contact when warranted.

9. Safety & Security Acknowledgment

Students are subject to check-in and check-out procedures.

Permitted bags and belongings may be inspected consistent with JAM CITY policy and applicable law.

JAM CITY may use security personnel during events.

Security cameras may operate in permitted public/common and exterior areas, but not bathrooms or other private areas.

Students must remain in designated JAM CITY areas and may not admit anyone through unauthorized entrances.

10. 1:00 AM Pickup & Late-Pickup Policy

JAM CITY closes at 1:00 AM. Non-driving students must be picked up promptly by a parent/guardian or authorized adult. Students will not be instructed to wait alone outside. Repeated late pickups may result in suspension of attendance privileges. If staff cannot reach an authorized adult and believe the student's safety is at risk, appropriate authorities may be contacted.

I understand and agree to the 1:00 AM pickup requirement.

11. Emergency Medical Authorization

If my student becomes ill or injured while attending JAM CITY, I authorize JAM CITY staff to contact me and/or emergency medical services when reasonably necessary.

I acknowledge this emergency medical authorization.

12. Photo & Video Permission

YES — JAM CITY may use photos/videos containing my student for JAM CITY promotional purposes.

NO — I do not give promotional photo/video permission.

13. Electronic Acknowledgment

I certify that I am the student's parent/legal guardian or otherwise legally authorized to register the student. I confirm that the information provided is accurate and that I have reviewed the JAM CITY policies above. Nothing in this form is intended to waive rights or responsibilities that cannot legally be waived.

Parent/Guardian Full Legal Name *

Date *

Student Full Name *

By checking this box and submitting, I affirm that the typed name above is my electronic acknowledgment of this registration and agreement.

Business-use note: Have a Georgia attorney and your insurance carrier review the final online waiver, privacy practices, minor supervision, transportation, emergency, and electronic-signature language before launch.