Ardea Kids Club

Child's Name*

First NameLast Name

Participant's Date of Birth*

Date

Age*

Address*

Address

Street Address Line 2

CityState

Zip

Parent 1 Name*

Parent 1 Cell*

Parent 2 Name*

Parent 2 Cell*

Member #*

Emergency Contact*

Phone*

Relationship to Child*

Other Special Information

Favorite Foods

Favorite Activities

Full Name of Participant*

Participant's Date of Birth*

Date

Allergies (Do not leave blank)*

Medications*

Medical History (ex., Diabetes or Epilepsy), Special Conditions/Needs*

Family Physician*

Phone*

Insurance Company*

Phone*

Group/Policy No*

For your convenience, Kids Club and Kids Camp fees are billed to your Member account.

Please sign below to give permission for Ardea Country Club to charge your Birdies kids club and/ or camp dues to your member account.

Member Number*

Signature*

Date*

Date

Participant*

Address*

Address

Street Address Line 2

City, State, Zip

Parent/ Legal Guardian:*

Phone Number*

Email*

example@example.com

Emergency Contact*

Relationship*

Phone*

Activity: Participation in 2023-2024 Kids Club/Camp, including all indoor and outdoor activities related there to at Ardea Country Club. Parent/Legal Guardian agrees to read and cooperate with any and all rules and policies of the Activity and understands that all sick or disciplinary rules will be enforced at the discretion of the Activity staff.

ASSUMPTION OF RISK AND RELEASE AGREEMENT

Assumption of Risk: Child and I are aware that the Activity involves inherent risks, dangers, and hazards that can result in serious personal injury or death. Child and I are also aware that the Club facilities and/or equipment contain dangers and can cause serious injury or death. Child and I hereby freely agree to assume and accept all known and unknown risks of injury arising out of the Activity, including injury or death that results from Club's negligence, design of the facility and/or equipment, or from any third party.

Release and Indemnity: In exchange for the Club allowing Child to participate in the Activity, Child and I, on our own behalf and on behalf of our respective family members, heirs, beneficiaries, assigns and all parties claiming by, through or under either or both of us, do hereby RELEASE, INDEMNIFY AND HOLD HARMLESS the Club, its parent, affiliated and subsidiary companies as well as all of their respective officers, directors, agents, contractors, employees, heirs, successors, assigns, volunteers and guests from all liability for any injury, death, illness (including but not limited to COVID-19), loss or damage connected in any way whatsoever to participation in the Activity, including that which may result, directly or indirectly, in whole or in part, from the negligence of the Club, the negligence or willful misconduct of any third party, or from the design of the facility and/or equipment.

Medical: Child and I give consent to emergency medical care and transportation in order to obtain treatment in the event of injury, as the Club may deem appropriate, and I agree to accept full responsibility for the payment of all costs for same. The release, indemnity and hold harmless provisions set forth hereinabove extend to any damage or loss arising out of the medical treatment and transportation provided in the event of an emergency.

Property Loss: All personal property brought to the Activity is brought at the sole risk of the Child as to its theft, damage or loss.

Photograph Permission: I give permission for the Club to use, without limitation or obligation, photographs, film footage or tape recordings that may include child's image or voice for purposes of promoting the Club's programs.

Severability: Any provision or portion of this Agreement found to be invalid by the courts having jurisdiction shall be invalid only with respect to such provision or portion. The remaining provisions or portion hereof, shall be construed and enforced to the same effect as if such offending provisionor portion thereof had not been contained herein.

Health Statement: Neither Child nor anyone in Child's immediate family has suffered from or, to my knowledge, been exposed to COVID-19 within thepast 45 days. Neither Child nor anyone in Child's immediate family has experienced any of the following symptoms in the past seven days nor have they been on medication to alleviate any such symptoms in the past seven days: cough, sore throat, fever, shortness of breath, loss of smell and loss of taste. In the event Child or anyone in Child's immediate family experiences any of the foregoing symptoms, I will notify the Club immediately and will not bring Child back to the Club. I have authority to enter into this Agreement on behalf of the above-referenced Child and do hereby execute this Agreement on behalf of myself and Child.

Signature of Parent/Legal Guardian*

Date*

Date

To promote a safe, enjoyable experience for all involved, parents/guardians must read and review this Code of Conduct with their child.

Show respect for all others personnel as well as fellow children - no hitting, kicking, biting, throwing objects, spitting, verbal abuse or inappropriate language. Follow the directions provided by staff and pay attention to staff as well as the surroundings. Participate in camp activities with a positive attitude. Follow the posted pool rules and any rules specific to tennis and golf instruction. Leave all facilities and equipment in the same condition as they were found. Any damages will be the responsibility of the child's parent/guardian. Physical violence will not be tolerated and will result in immediate removal.

Remember: All children attending Birdies Kids Club or Camps represent the members of Ardea Country Club Community and are expected to conduct themselves in a manner that will make the membership proud. Should behavior problems arise, the Birdies Staff will address it with the child and inform the parent/guardian upon pick-up. In extreme cases where behavior interferes with the well-being of other children or disrupts enjoyment of Kids Club/Camp by other children, the child's parent/guardian may be contacted to immediately pick up the child.

I have read the Code of Conduct and reviewed it with my child, who has agreed to follow all rules and to conduct himself/herself in an appropriate manner. I understand that if my child does not adhere to the Code of Conduct, I may be required to pick up my child immediately.

Printed Name of Parent/Guardian*

Printed Name of Child*

Signature of Parent/Guardian*

Date*

Date

There will be opportunities in our Kids Club/ Camp (ex. rain day) where your child will watch videos/movies. Some of those may be rated PG. Some examples: Finding Nemo, The Jungle Book, etc. Please complete this form if you give your child permission to participate:

Please sign below if you give your child permission to watch PG movie/videos.

Printed Name of Parent/Guardian

Signature of Parent/Guardian

Date

For your convenience, all fees will be charged to your Ardea Country Club (or Club Account), provided you are entitled to charging privileges.
You Must make reservations to ensure your child's spot-otherwise, we have the right to turn your family away.
For your child's safety, parents are required to sign their children in and out Birdies. Parents must inform Birdies staff if an adult other than the one whom brought the child/children in will be picking them up. Proof of identification must be provided upon request.
Parents must remain on the Club premises while their children are in Birdies.
Children must be toilet trained. Ardea Country Club is not a licensed Day Care facility, as such we are not allowed to change diapers or feed infants/toddlers.
Ardea Country Club Staff reserves the right to refuse service for reasons of illness, hygiene, or behavior deemed detrimental to the enjoyment and/or safety of the other children.
For your child's convenience, Birdies offers a variety of children's toys. Please make no items/toys are brought from home. Movies will be playing in Birdies as background noise.
It is the parent's responsibility to inform Birdies staff of any pertinent medical information prior to checking in. Birdies staff reserves the right to refuse service to any children they feel would require undivided or special attention and, as a result, affect the quality of supervision the other children receive. Any member of the Birdies staff will not disperse medication at anytime.

BIRDIES STAFF IS NOT RESPONSIBLE FOR ANY LOST OR DAMAGED ITEMS.

Please sign below if you have read and understand all the rules and regulations of Ardea Country Club's Birdies Kids Club.

Parent Signature*

Date*

Date

CHILDREN'S INFORMATION PROFILE

EMERGENCY/ MEDICAL TREATMENT

ACTIVITY REGISTRATION - MINOR

CODE OF CONDUCT