NEHA Family Camp Childcare Waiver Form

We are so excited to have you join us for NEHA's Family Camp at Geneva Point Center on June 26 - June 29, 2024!

Please take time to fill out this Childcare Waiver form for any children who will be attending and utilitzing the Childcare room on site (ages 0-2 years old), and to familiarize yourself with our policies.

Filling this form out beforehand will save us and you time at check-in. You may see repeat questions from the registration form you previously filled out; we ask that you complete this waiver in the event that information has changed.

Please list full names of any children attending Family Camp and utilizing the childcare (0-2 year old) room.*

Parent/Guardian Name*

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Emergency Contact's Relationship to Child*

Will Emergency Contact be at Family Camp*

YesNoUnknown

Does NEHA have permission to post pictures of your child/children for promotional purposes?*

YesNoOther

Childcare Policies and Procedures

For the well-being of other children, please refrain from bringing a sick child to childcare. Examples: Fever/productive cough/excessive runny nose/nausea.
NEHA is not responsible for items lost in childcare. Please be sure to exit childcare with the same items you arrived with.
Parents/guardians agree to have access to the phone associated with the number listed above at all times while children are in childcare.
Children will only be released to the person who dropped them off unless otherwise notified.
Childcare Staff Leads may change diapers as needed. Childcare Leads are also the only adults who take children to the bathroom. Volunteers are never given that job as a protection for all and that way it is sanitary and consistent. Please let the childcare staff know if you would not like your child to be changed by a Childcare Lead and you would rather be contacted for this purpose.
Children with food allergies: if your child has a food allergy, please provide their own labeled snack/drink. In the case that childcare is providing snacks and drinks to children, parents/guardians of children with allergies must approve all items before leaving childcare.

I, the undersigned, hereby hold harmless, waive and release New England Hemophilia Association (NEHA) and Geneva Point Center as well as NEHA's childcare workers, officers, representatives, agents, organizers, and successors from liability as a result of (1) moderate and severe personal injury, (2) property damage, (3) disability, (4) death, and (5) sickness or disease including, without limitation, COVID-19 while the above child/children are enrolled in childcare and, if applicable, at an off-site Field Trip. I have read, understand, and agree to adhere to the childcare policies and procedures of NEHA listed above.

Liability Waiver*

AGREEDISAGREE

By typing your full name here you confirm that all above information listed in this waiver has been completed accurately.*

Typing your full name here marks your signature

Childcare Waiver Form

Parent/Guardian Information

LIABILITY WAIVER