I represent that I am the parent, legal guardian, or authorized individual of each child on this registration form and that I, on behalf of myself, my spouse, listed child(ren), or the parents/legal guardians of each listed child(ren) on this Agreement Form, enter into this Agreement Form (Agreement) with Village Playcare, also known as Negangard Development, LLC . From this moment forward each designated child on the Agreement form will be referred to as “my Child”, I will be represented as the “parent”, and Village Playcare will be referred to as “VP”.
Facility Use. I understand that “VP” is a drop-in childcare and provides care on a non-routine basis. I further understand that “VP” is a legally licensed exempt facility due to its nature of business, that provides quiet and active playtime, to include but not limited to, arts and crafts and play equipment. If a child is in “VP”’s care during a meal time, I understand that I can choose to bring a peanut-free meal in with my child or a meal can be purchased from “VP”. I also understand that if a meal is not provided for my child and my child is present during a meal time, a meal will be provided at my cost. I also understand that the facility at “VP” is used for all day seasonal camps that are available to school-aged children.
Future Visits. The Registration Form, including this Agreement page, will be kept on file with “VP” and constitutes binding obligations for any future visits my Child may make to “VP”. “VP” reserves the right to refuse admission to any child for any reason and without liability.
Payment. Payment for “VP” services are due upon each pickup and can be made in credit/debit card. The fee is calculated by multiplying the time elapsed from check-in to check-out by the rates posted at the time of the visit, and adding any other additional costs that have incurred, such as, late fees, meals, diapers, and retail items. If a package was purchased, time used will be posted against this package and any overage is to be paid in full at time of check-out with the same calculation as above. “VP” reserves the right to refuse payment by check and charges a fee for any returned checks.
Pick Up. Children are only released to those authorized on the Registration Form. All designated individuals must present a valid driver’s license or state issued identification card with information corresponding to the information provided on the Registration Form. Children will not be released if identification is not supplied.
Health and Illness. My Child is in excellent health and physical condition and has no medical, physical, or psychological condition which has not been disclosed to “VP” on the some missing language here.
Registration Form. My Child also does not have any infectious, contagious, or communicable diseases. If my child becomes sick with a contagious illness after visiting “VP”, and the visit was during the gestation period, I agree to notify “VP” as soon as possible. “VP”, in its discretion, will notify each family of those children who may have been exposed.
Medical Release. Although, it is the goal of “VP” to provide a safe environment, it is possible my child could get injured. If such an incident occurs, I authorize “VP” to follow its internal procedures, to include simple first aid deemed reasonably appropriate. I do understand however, that “VP” will not be required to strictly follow these guidelines when “VP” believes circumstances may require otherwise. In the event that “VP” determines that emergency medical attention is necessary for my Child, I authorize “VP” to act as my agent and give permission for my Child to be attended to by a physician. I further understand that “VP” only administers medications used in life threatening situations, which include: EpiPens and Inhalers, at their discretion. These medications must be provided to “VP” each visit and a Medication Authorization Form must be on file.
Safety/Indemnity. I agree that “VP” may take action, which it considers prudent to protect the safety of my Child, and other children visiting “VP”. I further agree that I hereby waive and release all rights, causes of action and claims against Village Playcare, Inc., its Officers, Directors, Agents, and Employees and all of its affiliates, for any loss, expense, damage or injury suffered by my Child or my property, including the possible negligence of “VP”, but excluding gross negligence and intentional misconduct, during the time my Child visited “VP”. I further agree that I hold “VP” harmless from all actions, claims or liability, including attorney fees and court costs, directly or indirectly caused by my Child or resulting from any inaccuracy or omission made by me in completing the Registration Form.
Additional Requirements. As a condition to my use of “VP”, I agree that I have accurately completed and signed the Registration Form and that “VP” will rely on this information while caring for my Child. I agree that I will pay all costs arising out of any action relating to this Agreement or the Registration Form for collection purposes or otherwise. By signing this release I appoint “VP” to provide temporary childcare for my Child at my own risk. I have been given an opportunity to ask questions and obtain answers to my satisfaction regarding all aspects of “VP”. I am not relying on any promises or statements made by “VP”, other than those written in the documents supplied to me by “VP”.
Refusal of Service. In order to maintain a positive and suitable environment for employees and guests, “VP” reserves the right to refuse service to any child, parent, or family for any reason, including the failure of the child, parent, or family to follow policies or rules of the “VP” staff and facility.
I understand that this release will be kept on file with Village Playcare and will continue in effect for this and any future visits my Child may make to “VP”. I HAVE READ THE AGREEMENT CAREFULLY AND FULLY UNDERSTAND THE CONTENT AND CONSEQUENCES OF THIS AGREEMENT BEFORE SIGNING