Nurturing Parenting Program Parent Registration Form

Nurturing Parenting Program Parent Registration Form

5:30 PM – 7:00 PM Location: Ski Town Early Learning Center - Steamboat Springs
Parent/Guardian Full Name*

First NameLast Name
Additional Parent/Guardian Name (if applicable)

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
County of Residence*
Where do you live?*

Steamboat SpringsHaydenSouth RouttNorth RouttOther
Please list any food restrictions or allergies
Are you willing to commit to attending all 5 sessions?*

YesNo
Child supervision will be provided - If you are planning to bring your kid(s) with you please fill out the information below.
Child 1

First NameLast Name
Date of Birth

MonthDayYear
Date
Comments/Allergies/Special Needs:
Child 2

First NameLast Name
Date of Birth

MonthDayYear
Date
Comments/Allergies/Special Needs:
Child 3

First NameLast Name
Date of Birth

MonthDayYear
Date
Comments/Allergies/Special Needs:

CHILD CARE LIABILITY WAIVER

READ THIS DOCUMENT COMPLETELY BEFORE SIGNING. ITS EFFECT IS TO RELEASE ROUTT COUNTY FROM ANY LIABILITY RESULTING FROM YOUR CHILD’S PARTICIPATION IN THE ACTIVITIES DESCRIBED BELOW AND TO WAIVE ALL CLAIMS FOR DAMAGES OR LOSSES AGAINST THE COUNTY THAT MAY ARISE FROM SUCH ACTIVITIES EVEN IF THEY RESULT FROM NEGLIGENCE.
Release from Responsibility, Assumption of Risk, and Waiver

I hereby knowingly and voluntarily enter into this waiver and release of liability on behalf of my Child (full name indicated above) and hereby waive all rights, claims or causes of action of any kind whatsoever arising out of Child’s participation in the child care provided during the Nurturing Parenting sessions, and do hereby release and forever discharge Routt County, its employees, managers, and volunteers, for any physical injury, psychological injury, economical loss, or emotional loss that my Child may suffer as a result of taking part in the child care.

I am aware of the risks associated with participating in child care. I understand that injuries or outcomes may arise from my own Child’s or others’ conduct or the condition of the child care location. Nonetheless, I assume all related risks, both known or unknown to me, of participation in the child care. I understand that I am solely responsible for any costs arising out of any bodily injury or property damage that my Child may sustain through their participation in normal or unusual acts associated with the child care, regardless of whose fault may be the cause of my injuries or damages, even if caused by carelessness or negligence, so long as the conduct which caused the injuries or damages was not grossly negligent, or willful and wanton.

I agree to indemnify and hold harmless Routt County against all claims, suits, or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by anyone, including attorney’s fees and related costs if litigation arises pursuant to any claims. If Routt County incurs any of these types of expenses, I agree to reimburse Routt County.

I hereby certify that I am the parent or guardian of the Child named above and do hereby give my consent for my Child to participate in child care. I certify that I have read this agreement and that I fully understand its content. I am aware that this is a release of liability and a contract and that I am agreeing to it of my own free will.

If any provision contained within this Release of Liability shall be deemed to be invalid, unlawful, or otherwise unenforceable, the remainder of this Release shall remain in full force and effect.

This Agreement shall be governed by and construed in accordance with the laws of the State of Colorado. The parties agree that the venue in any action to enforce or interpret this Release from Responsibility, Assumption of Risk, and Waiver shall be in the District Court for the Fourteenth Judicial District for the State of Colorado.
Facility Use & Liability Waiver
By signing this form, I acknowledge that Ski Town Early Learning Center is voluntarily providing its space for this event. Ski Town Early Learning Center is offering the use of its facility only and is not providing its license, programming, or oversight for this event. Ski Town Early Learning Center, its program, and its license are not liable for any activities, incidents, or outcomes occurring during this event.

I also acknowledge that any Ski Town Early Learning Center staff present at this event are working on behalf of First Impressions [or the organization responsible for their compensation] and not as representatives of Ski Town Early Learning Center.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Nurturing Parenting Program Parent Registration Form

Child supervision will be provided - If you are planning to bring your kid(s) with you please fill out the information below.

CHILD CARE LIABILITY WAIVER

Facility Use & Liability Waiver