Registration

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Fall 20 Information and Release Form

Vitals:

Child's Namefirst, last

Child's DOBmm/dd/yyyy

Ageapprox.

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Parent's/Caregiver's Name 1first, last

Phone 1best reachable

Email 1a valid email

Parent's/Caregiver's Name 2first, last

Phone 2best reachable

Email 2a valid email

Emergency Contactother than parent/caregiver

Relationshipto parent/caregiver/child

Phone 4best reachable

Allergies & Medical Conditionsplease list any alleries and/or medical conditions we should be aware of; in there aren't any, please write "none".

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________________________________________________

Pickup Info:

Authorized Adult 1 - other than parentname of person authorized to pick up your child other than parent; first, last

Relationshipto parent/caregiver/child

Phone 5best reachable

Authorized Adult 2 - other than parentname of person authorized to pick up your child other than parent; first, last

Relationshipto parent/caregiver/child

Phone 6best reachable

________________________________________________

Terms & Conditions:

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 Let's Playgroup is organized and always maintained with the students’ safety and security a top priority, but accidents may 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.
 
While Let’s Playgroup will follow and implement measures according to CDC and NYS DOH guidelines, I understand that there is a risk of exposure to COVID-19 associated with my child’s participation in playgroup, including but not limited to social contact and interaction with Let’s Playgroup’s employees and other children.
 
To help reduce the spread of COVID-19 and to protect Let’s Playgroup’s employees and other children, Let’s Playgroup encourages all children and parents to adhere to all safety and health guidelines, as outlined in Let’s Playgroup’s Fall 2020 guidelines , which also contain links to the guidelines from the CDC and NYS DOH.
 
Notwithstanding the foregoing, I understand that the above guidelines do not completely eliminate my child’s risk of exposure to COVID-19 and, should my child experience any COVID-19 related symptoms (such as fever, cough, body aches, or shortness o breath), I am advised to keep my child home, not to bring my child to Let’s Playgroup, and follow the advice of my healthcare provider, clinic, or hospital. In such case, I will immediately alert Let’s Playgroup of such symptoms.
 
Regardless of any steps taken by Let’s Playgroup to reduce the risks associated with the COVID-19 pandemic, I knowingly and freely, assume all such risks, both known and unknown, relating to my child’ care at Let’s Playgroup, including arising from, or relating to COVID-19.
 
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.

I agree to the terms listed in the "Release of Liability" above.Please initial here

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I have read and understood the Let's Playgroup Fall 2020 guidelinesPlease initial here

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Tuition, Payment & Cancellation *

Tuition for the fall semester can be paid in full or in four (4) installments.

A non-refundable deposit of 25% of the tuition is required and due upon execution of this agreement. The deposit will be applied towards the first installment, with the remaining three (3) installments due on the first day of October, November and December respectively.

If we have to cancel playgroup due to symptoms of illness, we will refund 50% of the missed days. If we have to close playgroup due to city/state regulations, we will refund any deposit minus the time already spent.

If a parent/family needs to cancel playgroup at any time during the course the fall semester, one month's notice shall be given and 50 % of the remaining tuition shall be paid, unless a suitable replacement is found.

I agree to the terms listed in the "Tuition, Payment & Cancellation" above.Please initial here

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Media Release*

I do hereby consent and agree that Let’s Playgroup - Playing with Nature has the right to take pictures and short videos of my child and use them on their own website and social media accounts without compensation. My child’s name and identity will not be revealed.

I agree to the terms listed in the "Media Release" above.Please initial here

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Signature*

By signing this form electronically I certify that my answers are correct and complete. I am the legal guardian/parent of the child listed above and I agree to the terms listed in this form .

By placing my initials in this box and typing my name below I am electronically signing this form.Please initial here

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Parent's/Caregiver's Namefirst, last

Today's Datemm/dd/yy

fall20registration

Register Here

Please Complete after Registration