November MORNING- Play & Learn Playgroup Registration & Waiver (Morning Session Only, 9:30a-11a)
Please, complete the registration form to reserve your spot in the playgroup.
Participant Waiver and Release for Minors
By submitting this form, the child(ren) has/have my permission to participate in any activity or use of equipment or facilities during classes held at Sierra Nevada Children's Services. I understand and acknowledge that activities surrounding playgroups and events at Sierra Nevada Children's Services may pose risks to my child(ren). I (we), as parent(s) or guardian(s) of the minor, do hereby, for my child, myself, my heirs, executors and administrators, release and forever discharge Sierra Nevada Children's Services and all officers, directors, employees, agents and volunteers of the organization, acting officially or otherwise, from any and all claims, demands, actions or causes of action which in any way arise from the minor's participation in the above noted event. I hereby certify that the minor(s) is/are my child(ren) and that their date of birth (listed on this form) is/are correct. I do hereby certify that to the best of my knowledge and belief said minor is in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs (if applicable).
Parent/Guardian's Name
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First Name
Last Name
Phone Number (for contact purposes only)
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Please enter a valid phone number.
Email
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example@example.com
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
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First Name
Last Name
Emergency Contact Phone Number
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Please enter a valid phone number.
Child(ren) Info
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Enter the number of children you're registering on the dates you would like to attend.
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I hereby advise that the named minor(s) has the following allergies, medicine reactions or unusual physical conditions, which should be made known to a treating physician: (If none, please type the word "none".):
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Sierra Nevada Children's Services (SNCS) requests that each parent/guardian signs this photo release permission slip, if you agree to have you and/or your child included in photographs, videotapes and/or recorded interviews to be published in print, internet, broadcast and/or videos for educational and advocacy purposes, public display, and other uses. I understand that photos, filmed or audio recordings will not be used for commercial gain and will not be sold to anyone for commercial use.
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Agree to Photo Release
Do Not Agree to Photo Release
Parent/Guardian Signature
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