Waiver and Consent Form

Waiver and Consent

Playgroup Program
Parent/Guardian Information
Name*

PrefixFirst NameLast Name
Relationship*
Phone Number*

Ex. +66 123456789
Email Address
Ex. Ilovebelingo@gmail.com
Address*
Emergency Contact

In the event of an emergency, please contact:
Name*

First NameLast Name
Phone Number*

Ex.+66123456789
Child Information
Click "Add Another Child" if you need to register more than one child*
Terms and Conditions

We appreciate your understanding and support in following these simple, important policies
Packages
- Credit validity depends on selected package.
- Packages are non-refundable and non-extendable.
Pick-up & Drop-off
- Please drop off and pick up on time.
- Delays over 15 minutes may incur a THB 300 late fee.
- Only the person listed on the pick-up sticker is authorized for check-in/out.
Health & Safety
- Classrooms and shared areas are cleaned regularly.
- Please keep your child home if they are feeling unwell.
Behavior & Wellbeing
- Gentle play, kindness, and sharing are encouraged.
- If needed, parents will be contacted for early pick-up in cases of distress or disruptive behavior.
Waiver & Consent

By checking "I Agree" and submitting this form, I confirm that I am the Parent or Guardian of the child named above. I understand that Belingo World provides a safe and nurturing environment, and I release the center and its staff from liability for minor injuries that may occur during regular play or care activities. I accept responsibility for any medical expenses if needed and authorize staff to respond appropriately in case of emergency. I also give consent for my child’s photo or video to be used in Belingo World’s internal or promotional materials when suitable.
Please confirm by providing your name and date
Parent/Guardian Name
Today's Date

MonthDayYear
Date
Thank you for your submission! We can’t wait to welcome your little one to our Belingo World family.
Should be Empty:

Waiver and Consent

Parent/Guardian Information

Emergency Contact

Child Information

Terms and Conditions

Waiver & Consent