Information and Release Form
Child's Namefirst, last
Child's DOBdd/mm/yy
Parent's/Caregiver's Name 1first, last
Phone 1best reachable
Parent's/Caregiver's Name 2first, last
Phone 2best reachable
Emergency Contactother than parent/caregiver
Relationshipto parent/caregiver/child
Phone 3best reachable
Allergies & Medical Conditionsplease list any alleries and/or medical conditions we should be aware of; in there aren't any, please write "none".
0 /


Pickup Info:
Authorized Adult 1name of person authorized to pick up your child; first, last
Relationshipto parent/caregiver/child
Phone 4best reachable
Authorized Adult 2name of person authorized to pick up your child; first, last
Relationshipto parent/caregiver/child
Phone 5best reachable


Please read carefully and acknowledge that you understand and agree to the terms set forth below by ticking the two checkboxes.

Release of Liability*

I acknowledge that playgroup is organized and always maintained with the students’ safety in mind, but accidents do happen.  I understand that playgroup is held outside in a public park and that my child will be participating in physical outdoor activities (incl. running & climbing), which may involve wood branches, sticks, stones and earth.

In consideration of Let's Playgroup accepting this registration and permitting the participation of the above named child in such activities, which I believe to be educational, on behalf of myself and my family, I hereby release, discharge, indemnify and hold harmless Let's Playgroup, its employees, representatives and agents from any and all claims, actions and liabilities arising out of or in connection with the above named child’s participation in any aspect of the activities provided, even in the case of Let's Playgroup's negligence.

Tuition & Payment*

A non- refundable deposit of 25% of the tuition fee is required to secure requested spot(s).

Payment of the entire tuition (minus deposit)  for the Fall 2019 playgroup is due in full on the first playgroup day of your child.


If you need to cancel a playgroup day for health or any other reasons,  a make up may be possible, but is not guaranteed. It will depend on availabilities on other days. Make ups are not transferable from one seasonal playgroup to the other. There are no refunds for cancellations.