Playgroup Registration
Pinecrest - XploreKidz
Child's Information
Has your child ever attended a Round Robin Playgroup?
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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
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.
Zipcode
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Relationship to Child
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Please Select
Mother
Father
Grandparent
Other
Waivers & Releases
Participation Waiver: Despite the high standard of care and level of attention to detail to ensure safety standards for you and your child, it still remains possible that during your participation in any of our classes or programs, both you and your child may be exposed to a variety of unforeseen hazards and risks. These risks include, but are not limited to serious personal injury and property damage (“Injuries and Damages”) caused by the condition of the indoor or outdoor premises. You understand and acknowledge that you may have to exercise extra care for you and your child. You further understand that Round Robin Playgroup INC does not have rescue or medical facilities or the expertise necessary to deal with any Injuries and Damages. You further As a willing participant in OUTDOOR and/or INDOOR classes with Round Robin Playgroup INC, my family and I agree to the following: You are the parent and/or lawful guardian of the child. You consent to the participation by the child in all activities conducted by Round Robin Playgroup ACTING ON BEHALF OF YOURSELF AND YOUR CHILD, AND TO THE EXTENT ALLOWED BY LAW, YOU HEREBY WAIVE AND AGREE TO RELEASE ANY CLAIMS OR LIABILITY WHICH YOU, YOUR CHILD, OR YOUR CHILD’S HEIRS AND SUCCESSORS MAY HAVE OR BELIEVE TO HAVE AGAINST Round Robin Playgroup AND ITS OFFICERS, EMPLOYEES, OR AGENTS FOR ANY INJURIES, LOSSES OR DAMAGES TO YOUR CHILD, YOUR CHILD’S PERSONAL PROPERTY AND YOUR PERSONAL PROPERTY. YOU AGREE TO BE RESPONSIBLE FOR, INDEMNIFY, AND HOLD HARMLESS Round Robin Playgroup FROM AND AGAINST ANY CLAIMS, SUITS, JUDGMENTS, OR COSTS WHICH MAY BE BROUGHT AGAINST Round Robin Playgroup, ITS OFFICERS, DIRECTORS, EMPLOYEES OR AGENTS FOR THE ACTUAL OR ALLEGED ACTS OR OMISSIONS OF YOU OR YOUR CHILD.
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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
Please note that due to the nature of social media, we require a media release form for registration. If you would prefer that our playgroup staff to not take/ share photos of your child, please let them know on the first day of playgroup. Thank you!
Media Release: I hereby grant permission, without reservation, to the Round Robin Playgroup (“RRP”), and those authorized by RRP, to take photographs and to make recordings of myself and my child, and to use them in original or modified form in all media now or hereafter known, with or without my child’s name or information about him/her, for the promotion, public education, and/or fundraising activities of the organization. I hold harmless and release and forever discharge RRP their officers, directors, agents, employees, independent contractors, affiliated agencies, licensees, and assignees from all claims, demands, and causes of action that I, my children, our heirs, representatives, executors, administrators, or other persons acting on behalf of my or my child(ren)’s estate, have now or in the future may have, relating to the above. I also agree that RRP will be the sole owner of all tangible and intangible rights in the above-mentioned photographs and recordings, with full power of disposition. [please see Terms & Conditions for further details]
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I have read the above and fully understand this release and its contents, and I consent on behalf of myself and my child(ren), a minor under the age of 18.
Terms & Conditions
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I hereby attest that all of the requested registration information is true, accurate, current, and complete. I accept the Terms & Conditions of Round Robin Playgroup Inc.
Signature
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Class Payment
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USD
Round Robin Playgroups RELIES on your tuition payment to keep our programs running and accessible to all. Unlike most youth programs, we welcome families of all income levels without asking for proof of need. If you are able, please make the full tuition payment, as it not only supports your child’s class but also funds our charitable programs for families with fewer resources. Your support makes this community possible.
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