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• Order number: 6034
• Date: January 12, 2026
• Total: $696.57
• Payment method: Credit / Debit Card

Order details

Product	Total
Tutoring (MATH MASTERY & CONFIDENCE LAB)-Design39 - 325.50, DATE: 01/08/2026 - 03/26/2026 TIME: 3:30 PM - 4:30 PM THUR/week × 2	$651.00
Subtotal:	$651.00
Shipping:	$45.57 via Merchant fee
Total:	$696.57
Payment method:	Credit / Debit Card

Billing Details
Emergency Contact Name & Number:	6692684816
How Did You Hear About Us:	School
What school does the Attendee attend?:	Chaparral Elementary
Waiver Release:	1
wavier:	RELEASE OF LIABILITY AND ASSUMPTION OF RISK The child(ren) named below (referred to as “I” or “me”) desire to engage in one or more of the following activities made available by Begg’s Brick Builders, Inc., a California not-for-profit corporation (the “Company”): (a) using the playground while on recess from educational activities; (b) playing tennis, and (c) swimming (the “Activity”). In consideration of being permitted by the Company to participate in the Activity and in recognition of the Company’s reliance hereon, I agree to all the terms and conditions set forth in this instrument (this “Release”). I AM AWARE AND UNDERSTAND THAT THE ACTIVITY IS A POTENTIALLY DANGEROUS ACTIVITY AND INVOLVES THE RISK OF SERIOUS INJURY, DISABILITY, DEATH, AND/OR PROPERTY DAMAGE. I ACKNOWLEDGE THAT ANY INJURIES THAT I SUSTAIN MAY RESULT FROM OR BE COMPOUNDED BY THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE COMPANY, INCLUDING NEGLIGENT EMERGENCY RESPONSE OR RESCUE OPERATIONS OF THE COMPANY. NOTWITHSTANDING THE RISK, I ACKNOWLEDGE THAT I AM KNOWINGLY AND VOLUNTARILY PARTICIPATING IN THE ACTIVITY WITH AN EXPRESS UNDERSTANDING OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DISABILITY, DEATH, OR PROPERTY DAMAGE ARISING FROM MY PARTICIPATION IN THE ACTIVITY, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE COMPANY OR OTHERWISE. I hereby expressly waive and release any and all claims which I may have, or which I may hereafter have, whether known or unknown, against the Company, and its officers, directors, employees, agents, affiliates, members, successors, and assigns (collectively, “Releasees”), on account of injury, disability, death, or property damage arising out of or attributable to my participation in the Activity, whether arising out of the ordinary negligence of the Company or any Releases or otherwise. I covenant not to make or bring any such claim against the Company or any other Release, and forever release and discharge the Company and all other Releases from liability under such claims. This waiver and release does not extend to claims for gross negligence, intentional or reckless misconduct, or any other liabilities that California law does not permit to be released by agreement. I understand that by signing this release, I am waiving any and all claims, of any kind arising out of or attributable to my participation in the Activity, including those claims that may be unknown to me, or which I do not suspect to exist at this time. WITH THE INTENTION OF WAIVING ALL UNKNOWN AND UNSUSPECTED CLAIMS, I HEREBY EXPRESSLY WAIVE ALL RIGHTS, BENEFITS, AND PROTECTIONS I MAY HAVE UNDER CALIFORNIA CIVIL CODE SECTION 1542, WHICH READS AS FOLLOWS: A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party. I hereby consent to receive from any licensed hospital, physician, or medical personnel any medical treatment deemed necessary if I am injured or require medical attention during my participation in the Activity. I understand and agree that I am solely responsible for all costs related to such medical treatment and any related medical transportation and/or evacuation. This Release constitutes the sole and entire agreement of the Company and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Release is held invalid, illegal, or unenforceable, it shall be construed or limited in a manner that is enforceable and comes closest to the objectives intended by such provision, without rendering unenforceable the remaining provisions. This Release is binding on and shall inure to the benefit of the Company and me and their respective heirs, successors, and assigns. All matters arising out of or relating to this Release shall be governed by and construed in accordance with the internal laws of the State of California without giving effect to any choice or conflict of law provision or rule (whether of the State of California or any other jurisdiction). Any claim or cause of action arising under this Release may be brought only in the federal and state courts located in San Diego County, California, and I hereby consent to the exclusive jurisdiction of such courts. BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTOOD ALL OF THE TERMS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY FOR CLAIMS, WHETHER KNOWN OR UNKNOWN, ARISING OUT OF MY PARTICIPATION IN THE ACTIVITY.
Name of Parent or Legal Guardian::	Irina Smirnova
Signature Date:	2026/01/11
Child 1 Name:	Miroslav Smirnov
First Child Birthdate:	2016/09/15
Child 2 Name:	Milena Adelina Smirnova
Second Child Birthdate:	2019/08/03
First child Allergies:	No
Second child Allergies:	No

Billing address

Irina Smirnova
17524 Fairlie Rd
San Diego, CA 92128

6692648114

irina.spb.smirnova@gmail.com

Customer Signature