Kids Club

Registration

Step 1 of 3

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General Information

Mother's Name

Mother's Phone Number

Father's Name

Father's Phone Number

Name of Children (include last name if different from above)

Full name of child

Birthday

 

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Address

Street Address City ZIP Code

Home Phone

Work Phone

Physician Name

Physician Phone

Children Info

Persons authorized to pick up child (include Nanny/baby-sitters/family)

It is legal for either parent to pick up a child unless we have a copy of a court order restricting visitation.

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Allergies or medical situations we need to be aware of:

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Please check the box that you have read and understand the following guidelines for Kids Club at CLO:

Restrictions:

Consent

The Kids Club at CLO is for members while they are using the Club’s facilities. You must remain on the premises while your child is in the Kids Club. We reserve the right to deny Kids Club privileges to anyone abusing the time limits.

Consent

We reserve the right to refuse childcare to any child deemed too ill by Kid’s Club staff.

Consent

Any child posing a threat to other children will be dismissed.

Consent

Due to children that may have life threating food allergies, no outside food is allowed in Kids Club.

CLO Kids Club Disclaimer

Member/Parent hereby releases and forever discharges CLO from any and all claims, liabilities, costs, expenses, causes of action and attorney’s fees (collectively “Claims”) of every nature, character and description, known or unknown, which Member/Parent now or hereafter may own or hold including but not limited to Claims, arising from any of the matters referred to in Paragraphs 1-3 below. Member/Parent understands that Member/Parent may discover facts different from or in addition to any claims herein released. Notwithstanding such, Member/Parent agrees that this release shall remain effective in all respects and waives the right to make any new or different Claims in regards to the new facts and waives any rights it many have under Federal or State Laws invalidating such a release of unknown Claims. Member/Parent assumes all risk associated with Members/Parent use of CLO, including but not limited to the matters referred to in Paragraphs 1-3 below. Member/Parent has or may obtain insurance at Member’s/Parent cost against any Claims arising in connection with the matters referred to Paragraphs1-3 below and if Member/Parent has such insurance, Member hereby agrees to look solely to Members/Parent’s insurance carrier to resolve any Claim and in such event Member /Parent hereby waives all rights of subrogation which Member/Parent may have against CLO.

1. Member/Parent understands that CLO provides childcare for the Member/Parent’s convenience while using the CLO and that Members/Parents child may play with toys or equipment owned by CLO and to leave CLO under supervision of staff for walks or field trips.
2. Member/Parent understands that each member of the CLO childcare staff is CPR trained and that if Member/Parent cannot be previously contacted, the CLO childcare staff may administer minor first aid or emergency first aid, or may transport Member’s/Parent’s child to a hospital if necessary.
3. Member/Parent understands that personal items brought on the CLO premises may be subject to loss of theft.
4. CLO will not assume responsibility for a child who has not been signed in upon arrival for that day.
5. I give permission for photographs to be taken of my child for the purpose of advertising the CLO Kids Club.

In the event legal action is required to enforce the terms of this Agreement, the prevailing party shall be entitled to reasonable attorney fees and costs.

Signature of Parent or Legal Guardian Date:(Required)