Enrolment and Indemnity Form

Enrolment and Indemnity Form
CHILDS DETAILS
Child's Name*

First NameMiddle NameLast Name
Gender*
Date of Birth*

MonthDayYear
Date
Address*

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*
(not parents/guardian)
Emergency Contact Number*
Doctors Practice and Name*
Doctors Number*
Does your child suffer from any allergies or medication restrictions?*

YesNo
Specify Allergies*
Any other health problems
MOTHER / GUARDIAN
Name*

First NameLast Name
Identity No*
Employer and Occupation*
Business Number*
Cell*
Email*
FATHER / GUARDIAN
Name*

First NameLast Name
Identity No*
Employer and Occupation*
Business Number*
Cell*
Email*
ENROLMENT OPTIONS
Preferred Start Date*

MonthDayYear
Date
Enrolment Options*
Preferred Attendance Days of the Week*

MondayTuesdayWednesdayThursdayFriday
Please note that selected days are not guaranteed and will only be confirmed at a later stage.
Snack

Peek-a-Boo provides a daily snack mostly consisting of sandwiches and seasonal fruit and on occasion noodles, sausages, yoghurt or other food varieties. Peek-a-Boo may also at times hand out sweets, ice lollies or do a baking activity. Please select from the list below if your child has any dietary restrictions.

Please note we have a nut free policy at our school and no food items containing nuts are provided to the children. Please ensure to make a note on the form if your child is allergic to nuts or any other item of food for our records.
Diet Requirements*

NoneLactose intoleranceVegetarianismVeganismKosherKetoDiabetesDairy-freeLow carbGluten intolerance or sensitivityFood allergies
Food Allergies*
Number of Siblings
Name and Age of Siblings
Has any Siblings attended Peek-a-Boo
How did you hear about Peek-a-Boo
We, the father mother and guardian (as the case may be) of the child described above (hereinafter referred to as the “child”), hereby agree:
1. To accept and abide by all the Rules and Regulations of 2022 (a copy of which has been handed to us) of Peek-a Boo playgroup (hereinafter referred to as Peek-a-Boo), with which Rules and Regulations we declare ourselves fully acquainted;
2. That while the persons in charge of Peek-a Boo will care for the child to the best of their ability, neither Peek-a-Boo, the owners of Peek-a-Boo, the employees of Peek-a-Boo nor any persons directly or indirectly connected to Peek-a-Boo (hereinafter collectively referred to as the “indemnified parties”), will be liable for any claims, losses, damages and expenses arising from any act or omission of all or any of the indemnified parties in relation to the child or from any accident or injury happening to the child while he/she is in the care or presence or situated on the premises of any of the indemnified parties, and agree to waive and abandon all and any claims which any of us may have against the indemnified parties, which may, at any time, arise as aforesaid, both in our personal capacity, and in our capacity as parent and/or guardian (as the case may be) of the child, and we expressly indemnify the indemnified parties against all and any claims, losses, damages and expenses arising directly or indirectly in connection with the child as contemplated in this paragraph 2;
3. To ensure that the child has been properly immunized against Whooping Cough, Diphtheria, Tetanus and Polio, and vaccinated against Tuberculosis and will furnish proof of this on request;
4. That the indemnified parties may give the required permission and sign the necessary written consent for the child to be subjected to surgery or other medical treatments, provided that this will be executed on the advice, and under the supervision, of a medical doctor.
Additional Documents*

I have read through the rules and regulations and have accepted and signed on every page.I have read through the illness policy and accepted and signed it.
Rules and Regulations Link Illness Policy Link
File Upload (For additional signed documents)

Cancelof
Thus done and signed at location*This the day* day of month* 20 year*
In the presence of the undersigned witnesses
MOTHER/PARENT/GUARDIAN*

Clear
FATHER/PARENT/GUARDIAN*

Clear
WITNESS*

Clear
WITNESS*

Clear

Photo Agreement
Dear Parent/Guardian:

During the school year, we enjoy taking photographs of the various school activities, showing the wonderful vibe at Peek-a-Boo and also keeping parents updated. Some of these photos may involve your child’s participation. Theses photos may be published through our website, social media pages, news bulletins and adverts.

We would therefore request your consent in allowing us to publish said photos which may involve your child, to the said platforms.

KINDLY SELECT ONE OF THE RESPONSES BELOW AND RETURN THIS COMPLETED FORM TO US, FOR OUR RECORDS.
Photo Release Consent*

I accept that all photos taken of my child while at school can be published on social media sites, Whatsapp communication group, Peek-a-Boo website, flyers or news bulletins.I accept that all photos taken of my child while at school MAY ONLY be shared on the Whatsapp communication group and GOOGLE TERM ALBUM (for current parents ONLY) and no other social media sites, websites, flyers etc. [Note: Peek-a-Boo is not held liable for what other parents do with the pictures sent in the communication platform and cannot be held liable if they choose to post them on their private social media sites]NO PICTURES OF MY CHILD SHOULD BE SHARED ON ANY PLATFORM (except in the form of a direct message for communication purposes only) [Note: Your child will be excluded from all group videos or shots]
Parent/ Guardians Name*

First NameLast Name
Child's Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Enrolment and Indemnity Form

CHILDS DETAILS

MOTHER / GUARDIAN

FATHER / GUARDIAN

ENROLMENT OPTIONS

Photo Agreement