TSS Open Gym Registration

I hereby give my consent for my child/dependent to participate in the sensory gym at The Speech Space, LLC. I am fully aware that participation in the sensory gym presents a risk of injury during treatment and evaluations. I am fully aware of and release liability of any damages that might occur as a result of my child's participation in or attendance at The Speech Space, LLC. Nonetheless, I, on my own behalf of my child/dependent do hereby release, indemnify and agree to hold harmless The Speech Space, LLC and all persons or entities associated with The Speech Space, LLC from any responsibility or liability for any and all claims, costs, demands, damages, losses, causes of actions and expenses (including, without limitation, reasonable attorneys' fees) arising out of or resulting from my child's involvement with any therapy treatments or evaluations, including without limitation, any personal injury, disability, property damages, or property losses incurred by me or my child during or as a result of treatments or evaluations conducted by The Speech Space, LLC. I understand that the participant’s family medical insurance policy must cover any medical costs incurred in case of an accident, or be held personally responsible, in the instance that the participant’s family is not covered under a health insurance policy.

Please do not bring a sick child to Open Gym. No child or adult who presents with or who has experienced any of the following indicators in the last 24 hours will be permitted into the clinic: fever of 100.4°F or above, sore throat, diarrhea, vomiting, any rash that could be contagious, lice, severe cough different from baseline. If a family cancels their reservation for illness, a session will be credited back to them to use for a future date. If a family does not attend for any other reason, no credit will be given. The family pays for the whole session reservation, regardless of how much time they spend at the session.