Trial Class Request Form

Trial Class Request Form

Diamond Bar Magikid Robotics Lab
Name of Student*

First NameLast Name
Student Date of Birth*

MonthDayYear
Date
MaleFemale
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Current School*
Grade in Fall 2025*
Name of Parent/Guardian *

First NameLast Name
Email*
example@example.com
Phone Number (if failed to input your number, please copy&paste from another platform)*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Pre Robot Rookie 4-5 YORobot Rookie 5-7 YORobot Explorer 7-9 YOScratch Jr 5-7 YOScratch 3.0 7-9 YO3D Modeling 8+ YOPython 9+ YOVEX IQ 9+ YOVEX V5 12+ YOOther
MondayTuesdayWednesdayThursdayFridaySaturdaySunday
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If referred by a friend, please list his or her full name as well as their child(ren).
Trial Class Fee 试课费:

$50/person - Robotics Class (1.5 Hours)
$35/person - Coding Class (1 Hour) and Pre Robot Rookie Class (1 Hour)
1. The trial class fee must be paid before the class starts.
2. If you register for a course package on the same day as your trial class, you will receive one free class, which will be added to your chosen course package.
  You must register on the same day. Otherwise, no free class will be added.
3. The trial fee is non-refundable unless you reschedule or cancel at least 24 hours before the scheduled trial class.
4. Credit card transaction fee of 4% is non-refundable under any circumstances.
$50/人：机器人课（1.5小时）
$35/人：编程课（1小时）和初级机器人课（1小时）
1. 试课费需在上课前预付。
2. 如果您在试课当天报名课程，您将获得一节免费课，并添加到您选择的课包中。
  必须在试课当天报名，否则不会赠送免费课。
3. 除非您在试课开始前至少24小时取消或重新安排试课时间，否则试课费不予退还。
4. 无论任何情况，付款产生的4%信用卡手续费无法退还。
I agree to the trial class terms and conditions listed above.*
Note:

We will try our best to accomodate your chosen date for trial class, but please note that it is not guaranteed. We will send you confirmation with exact date and time for your trial session.

Please also note that the time and day you have your trial session may not be the day and time for your regular sessions. It is subject to change.
PARENT PERMISSION AND WAIVER: We, the parents/guardians of the student named below, understand the nature of the classes and activities that take place at Magikid Lab Diamond Bar located at 3211 S Brea Canyon Rd #A, Diamond Bar CA 91765. We hereby grant permission for our son/daughter to participate. We understand that adequate and appropriate supervision will be provided. In the event of an injury requiring medical attention, I hereby grant permission to the supervising teacher(s) or staff (including volunteers) to attend to my son/daughter. If the injury warrants further medical attention, I expect every effort will be made to contact me to receive my specific authorization before action is taken. If efforts to contact me are unsuccessful, I grant permission for necessary medical treatment to be given. In addition, I hereby give my permission to the supervising teacher(s) or staff (including volunteers) to take my child to the physician, dentist, or to the hospital if an accident or serious illness occurs on the trip and I cannot be located. We recognize that unanticipated situations and problems can arise on any trip, school-sponsored or otherwise, which situations or problems are not reasonably within the control of the supervising teacher(s) or staff (including volunteers). We therefore agree to release and hold harmless the Directors, agents, officers, employees, and volunteers of Banana Education Inc. DBA Magikid Lab Diamond Bar from any and all liability, claims, suits, demands, judgments, costs, interest and expense, including attorneys' fees and costs, arising from such activities, including any accident or injury to the student and the costs of medical services, or any cause beyond the control of Magikid Lab Diamond Bar, including, but not limited to, natural disasters, civil disturbances, acts of terrorism, and wars.We have read and understand the contents of this form and voluntarily sign it, waiving any right to claim damages or compensation against Magikid Lab Diamond Bar or its representatives. This agreement shall remain in force for the duration of our child's participation in Magikid Lab Diamond Bar programs or activities. 家长许可和豁免书：我/我们，以下为家长/监护人，充分了解以下地址的 Magikid Lab Diamond Bar 的课程和活动的性质。我们特此允许我们的儿子/女儿参加该课程和活动。我们理解 Magikid Lab Diamond Bar 将提供充分和适当的监督。如果发生需要医疗救治的伤害，我特此允许监督教师或工作人员（包括志愿者）照顾我的儿子/女儿。如果受伤需要进一步的医疗护理，我希望在采取行动之前尽一切努力与我联系以获得我的具体授权。如果联系我的努力不成功，我同意给予必要的医疗。此外，如果在旅途中发生事故或严重疾病并且无法联系到我，我在此允许监督教师或工作人员（包括志愿者）带我的孩子去看医生、牙医或急诊。并且，我们认识到，任何旅行、学校活动或其他都可能出现意外情况和问题，这些情况或问题不在监督教师或工作人员（包括志愿者）的合理控制范围内。我们进一步同意免除 Banana Education Inc. DB Magikid Lab Diamond Bar 的董事、代理人、官员、员工和志愿者的任何和所有责任、索赔、诉讼、要求、判决、由此类活动引起的成本、利息和开支（包括律师费和成本），包括学生的任何事故或伤害以及医疗服务费用，或 Magikid Lab Diamond Bar 无法控制的任何原因，包括但不限于自然灾害、内乱、恐怖主义行为和战争。 I agree to terms and conditions mentioned above.*

YesNo
Signature of Parent/Guardian*
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Robotics Class
$50.00 Quantity



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$50.00 Quantity



Coding Class or Pre Rookie Class
$35.00 Quantity



VEX V5 Robotics Class
$70.00 Quantity



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