I am the legal parent or guardian of the participant.

Waiver Agreement

Play with Purpose Club is a structured, OT-led group enrichment program held at The Littles Play Café in Latham, New York. The program is led by licensed Occupational Therapists (OTR/L) and supported by on-site nursing staff. Activities include movement-based programming, sensory-based play, gross motor activities, structured crafts, and regulation strategies. This program is a group enrichment experience and is not individual occupational therapy services and does not establish an ongoing therapist-client relationship. This program is not a licensed children’s day camp under New York State Department of Health regulations.

Parents/guardians may:

Drop off their child for the full 3-hour session, OR Remain on-site at The Littles Play Cafe during programming. If a parent leaves the premises, they must remain reachable by phone at all times and agree to return promptly if contacted. Balanced Living Wellness, LLC reserves the right to require parental presence or early pick-up if a child is unable to safely participate in the group setting.

For the safety of all participants: Children may NOT attend camp if they have: fever within the past 24 hours, vomiting or diarrhea within the past 24 hours, uncontrolled cough, contagious rash, active strep throat, influenza, COVID-19, RSV, or other communicable illness. Any condition deemed contagious by medical standards. Children must be fever-free for 24 hours without medication before returning. If a child becomes ill during camp, the parent/guardian will be contacted for immediate pick-up. No refunds or credits will be issued for absences due to illness. By signing below, I confirm that my child is illness-free at the time of attendance and that I will follow this exclusion policy.

I affirm that:

I have disclosed all relevant medical conditions, allergies, medications, and behavioral considerations.

My child is physically able to participate in movement-based activities.

My child does not require one-to-one medical supervision.

I authorize program staff to: Provide basic first aid, contact emergency medical services (EMS), contact the listed emergency contact. I understand that nursing staff onsite provides general health oversight and emergency response only and does not provide individualized medical treatment. I accept full financial responsibility for any medical care rendered.

I acknowledge that participation in physical, sensory, and group-based activities involves inherent risks, including but not limited to: falls, minor injuries, collisions, physical exertion, equipment-related incidents. I voluntarily assume all risks associated with participation.

To the fullest extent permitted under New York law, I release and hold harmless: Balanced Living Wellness, LLC, its licensed occupational therapists, on-site nursing staff, independent contractors, The Littles Play Café, And all employees, representatives, and agents from any and all claims, demands, liabilities, damages, or causes of action arising from participation in this program, except in cases of gross negligence or willful misconduct.

I agree to indemnify and hold harmless Balanced Living Wellness, LLC and its representatives from any claims, damages, or liabilities arising from: failure to disclose medical information, failure to follow illness policy, behavioral actions of my child resulting in harm to others, violation of program policies.

This is a structured group environment. Balanced Living Wellness, LLC, reserves the right to dismiss a participant without refund if: the child's behavior presents a safety risk, the child requires one-to-one supervision beyond group capacity, the parent fails to disclose relevant medical or behavioral information, or policies are violated.

I understand that: Socks are required in the play area, the play area is an illness-free zone, a separate Littles Play Café waiver must be completed, Balanced Living Wellness, LLC, is not responsible for policies of The Littles Play Café I agree to comply with all facility rules.

I grant permission for photographs and video recordings of my child to be used for: Marketing, Social media, Educational materials. No identifying information will be published without additional consent.

Payment is collected in full at registration. All registrations are non-refundable. No refunds or credits will be issued for: Illness, Scheduling conflicts, Missed days, Behavioral dismissal, Voluntary withdrawal. In the event the program is canceled by Balanced Living Wellness, LLC, a full refund will be issued.

Enrollment is not complete until: Payment is received, this agreement is signed,  required facility waiver is completed. Failure to complete required forms within 48 hours may result in cancellation of enrollment without refund.

This agreement shall be governed by and construed in accordance with the laws of the State of New York.

By signing below, I confirm that: I have read and understand this agreement. I voluntarily agree to all terms. I am the legal parent or guardian of the participant.