Grades TK to 5
Please fill out a seperate pick up authorization form at the center if you wish to authorize adults (18 years and older) other than the guardians mentioned above to pick upld your child.
This is the email for confirmation receipt.
Jan 2nd, 3rd, 6th, 7th
Terms and Conditions
Please read this carefully and be aware in registering yourself, your child, or ward for participation inthis program, you will be waiving and releasing all claims for injuries you or your minor child/ward might sustain arising out of the RootsForKids Afterschool program (hereinafter referred to as “program”).
As a participant in the program or the parent/guardian of a participant in the program, I recognizeand agree to assume the full risk of any injuries, including death, damages, or loss which I or my minor child/ward may sustain as a result of participating in any or all activities connected with orassociated with such program.
I agree to waive and relinquish all claims my minor child/ward or I may have as a result ofparticipating in this program against the person(s) conducting this program and the facility where the program is being conducted.
I do hereby fully release and discharge the facility, program and its officers, agents, servants, and employees from injuries, including death, damage, or loss which I or my minor child/ward may have or which may accrue to me or my minor child/ward on account of my participation in the program.
I further agree to indemnify, hold harmless and defend this program and its officers, agents, servants,and employees from any and all claims associated with the activities of the program. I/We carry personal medical/dental/vision insurance for my/our child in case of accident, injury or illness. Incase of accident or sickness, I consent to emergency medical care provided by ambulance or hospitalpersonnel.
I have read and understood the above Waiver and Release of All Claims and agree to abide by the aforementioned policies.
Summary of Charges
You should receive a copy of your submission via email to the email address(es) provided but we strongly recommend to PRINT a copy for your records.
Pls contact us at 650-720-5437 OR email us at email@example.com for any assistance or questions.