The Nest: Lactation Clinic
Tuesday July 15, 2025
Child's Information
Has your child ever attended a class at The Nest?
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Yes
No
Child's Name
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First Name
Last Name
Child's Age
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0-6 months
6-12 months
1 year
2 years
3 years
Legal Guardian Information
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Zipcode
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Relationship to Child
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Mother
Father
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Liability Release
READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF ROUND ROBIN PLAYGROUP INC (AKA THE NEST) USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD'S RIGHT AND YOUR RIGHT TO RECOVER FROM ROUND ROBIN PLAYGROUP INC (AKA THE NEST) IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND ROUND ROBIN PLAYGROUP INC (AKA THE NEST) HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.Round Robin Playgroup Inc (aka The Nest) Customer Release of Liability, Indemnity Agreement, and Assumption of RiskNOTICE TO THE MINOR CHILD'S NATURAL GUARDIANIn consideration of being permitted by Round Robin Playgroup Inc (aka The Nest) (hereinafter “Round Robin Playgroup Inc (aka The Nest)”) to participate in its activities and to use its equipment and facilities, now and in the future, I ___________________________ as parent or legal guardian of ______________________________ a minor (hereinafter “Minor”), hereby grant the permission necessary to allow Minor to participate in all activities at this Round Robin Playgroup Inc (aka The Nest) location and agree with all the terms of this Release of Liability, Indemnity Agreement, and Assumption of Risk Agreement (hereinafter “Agreement”). I, in my own behalf and on behalf of Minor, further agree to release, indemnify and discharge Round Robin Playgroup Inc (aka The Nest), its agents, owners, shareholders, directors, partners, employees, volunteers, manufacturers, participants, lessors, affiliates, its subsidiaries, related and affiliated entities, successors and assigns (hereinafter “Released Parties”), on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:I understand and acknowledge that the activity the Minor is about to voluntarily engage in as a participant bears certain known risks and unanticipated risks which could result in physical, emotional, or mental injury, paralysis, illness or disease, death, or damage to Minor, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activities at Round Robin Playgroup Inc (aka The Nest).The risks include, among other things: Use of Round Robin Playgroup Inc (aka The Nest) equipment entails certain risks that simply cannot be eliminated without jeopardizing the essential qualities of the activity. Use of equipment may expose participants to the usual risk of cuts, scrapes, bruises, and rug burns. Other more serious risks exist as well. Participants may fall off equipment, sprain, injure, or break fingers, toes, wrists, feet, legs, back, or neck, and can suffer more serious bodily injuries as well. In any event, if Minor is injured and may require medical assistance, you as parent or legal guardian will assume full liability and responsibility for the expenses.Furthermore, Round Robin Playgroup Inc (aka The Nest) employees have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant’s fitness or abilities. They may give incomplete warnings or instructions, and the equipment being used might become loose, out of adjustment, or malfunction. There is also a risk that Round Robin Playgroup Inc (aka The Nest) employees may be negligent in, among other things, monitoring and supervising use of its equipment and facilities and in the maintenance and repair of its equipment and facilities.I agree that this Release of Liability, Indemnity Agreement, and Assumption of Risk Agreement is made on behalf of that Minor participant and that all of the releases, waivers and promises herein are binding on that Minor participant. I represent that I have full authority as Parent or Legal Guardian of the minor participant to bind the Minor participant to this Agreement.I expressly agree and promise to accept and assume all of the risks existing in this activity on behalf of Minor. The Minor’s participation in this activity is purely voluntary, and I elect to have Minor participate in spite of all the risks.I hereby voluntarily release, forever discharge, and agree to defend, indemnify and hold harmless Round Robin Playgroup Inc (aka The Nest) and all Released Parties from any and all claims, demands, or causes of action, which are in any way connected with Minor’s participation in this activity or use of Round Robin Playgroup Inc (aka The Nest) equipment or facilities, including any such claims which allege negligent acts or omissions of Released Parties.I indemnify and save and hold harmless Round Robin Playgroup Inc (aka The Nest) and the Released Parties against any loss, liability, damage or cost that may incur arising out of or in any way connected with the Minor’s use of Round Robin Playgroup Inc (aka The Nest) equipment or gear provided therewith or any acts or omissions of the Released Parties.Should Round Robin Playgroup Inc (aka The Nest) or anyone acting on its behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. This means that I will pay all of those attorney’s fees and costs myself.I certify that I have adequate insurance to cover any injury or damage that Minor may cause or suffer while participating in all Round Robin Playgroup Inc (aka The Nest) activities, or else I agree to bear the costs of such injury or damage to Minor myself. I further certify that I am willing to assume the risk of any medical or physical condition that Minor may have.I expressly agree that this Agreement is governed by the State of Florida and is intended to be as broad and inclusive as permitted by Florida law, and that in the event any portion of this Agreement is determined to be invalid, illegal, or unenforceable, the validity, legality and enforceability of the balance of the Agreement shall not be affected or impaired in any way and shall continue in full legal force and effect. In the event that I file a lawsuit against Round Robin Playgroup Inc (aka The Nest), I agree to do so solely in the State of Florida and I further agree that the substantive law of the State of Florida shall apply in that action without regard to the conflict of the law rules of that state.I further agree to defend, indemnify and hold harmless Round Robin Playgroup Inc (aka The Nest) from any and all claims or lawsuits for personal injury, property damage or otherwise which are brought by, or on behalf of the Minor, and which are in any way connected with such use or participation by the Minor, including injuries or damages caused by the negligence of Released Parties, except injuries or damages caused by the sole negligence or willful misconduct of the party seeking indemnity.I certify that, to the best of my knowledge, the Minor does not have a health condition that would make it inadvisable for the Minor to participate in Round Robin Playgroup Inc (aka The Nest) activities.I agree to grant Round Robin Playgroup Inc (aka The Nest) and all Related Parties, the irrevocable right and permission to photograph and/or record me or Minor in connection with Round Robin Playgroup Inc (aka The Nest) to use the photograph and/or recording for all purposes, including advertising and promotional purposes, in any manner in any and all media now or hereafter known, in perpetuity throughout the world, without restriction as to alteration. I waive any right to inspect or approve the use of the photograph and/or recording, and acknowledge and agree that the rights granted to this release are without compensation of any kind. All photographs and/or recordings are exclusive to Round Robin Playgroup Inc (aka The Nest).In consideration of not being required to sign a fresh copy of this Agreement before each visit, I further agree that this Agreement shall apply to all future visits of the Minor to this Round Robin Playgroup Inc (aka The Nest) location.By signing this Agreement, I acknowledge that I have had sufficient opportunity to read this entire Agreement, I understand it completely, I understand that it affects my legal rights, and I agree to be bound by its terms. I also agree if anyone is hurt or property damaged during the Minor’s participation in this activity, I may be found by a court of law to have waived my or the Minor participant’s right to maintain a lawsuit against Round Robin Playgroup Inc (aka The Nest) and the Released Parties on the basis of any claim from which I have released them herein.By signing this agreement, you are acknowledging that Round Robin Playgroup Inc (aka The Nest) is not a licensed Day Care.
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I have read the above and I agree & consent on behalf of myself and my child(ren) to participate in Round Robin Playgroup (aka The Nest)
Signature
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OUR PROGRAMS RELY ON YOUR TUITION PAYMENT. Round Robin Playgroups makes a home for all families from our neighborhood. We are dedicated to keeping our program accessible to any Caregiver who is interested. We never ask for proof of need, we only ask that families can pay the most they can afford. Your payment keeps The Nest's doors open!
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