Kids Zone Registration & Parent Waiver

The Playful Pop Up
Kids Zone Registration & Parent Waiver

Please complete this form to register your child(ren).Sessions are 30 minutes and space is limited. ****** Payment will be collected after a session spot is confirmed. Please use this form to pre-register your child. Then visit the check in desk to find an available time. Once a time has been scheduled, you'll scan the QR Code at STEP 2, to pay and hold your child's spot. Thank you for giving us the opportunity to create some joy and fun for your child! - The Playful Pop Up Team
• Parent / Guardian Full Name (Required)
Please verify that you are human
Email

Confirmation Emailexample@example.com
Phone Number (We will use this to text/call you in case of emergency or if your child needs you to use the bathroom)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Secondary, Optional)
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Child Registration

Child #1
Child's Full Name
Preferred Name/Nickname (Optional)
Date of Birth

MonthDayYear
Date
Age
Does this child have any allergies?
If you selected Yes, please list all allergies
If you selected No, type "None"
Response to allergic reaction (Select all that apply)

Other
Any special needs, sensory considerations, or information we should know? (this information will be kept confidential and only shared with staff who will be working with this child)
If not applicable, enter "N/A"
Assigned Session Time (Guests Can Not See This Field - Staff Facing Only)
(example: 1:00-1:30pm)
Approved to Pay? (Guests Can Not See This Field - Staff Facing Only)
Only change this to "Yes- Send Invoice" after you have confirmed there is an open spot for the child.
Additional Child Registration
Do you need to register a second child?
Child Details
Child's Full Name
Preferred Name/Nickname (optional)
Date of Birth

MonthDayYear
Date
Age
Does this child have any allergies?
If you selected Yes, please list all allergies
If you selected No, type "None"
Response to allergic reaction (Select all that apply)

Other
Any special needs, sensory considerations, or information we should know? (this information will be kept confidential and only shared with staff who will be working with this child)
If not applicable, enter "N/A"
Assigned Session Time (Guests Can Not See This Field - Staff Facing Only)
(example: 1:00-1:30pm)
Approved to Pay? (Guests Can Not See This Field - Staff Facing Only)
Only change this to "Yes- Send Invoice" after you have confirmed there is an open spot for the child.
Do you need to register a third child?
Child's Full Name
Preferred Name/Nickname (optional)
Date of Birth

MonthDayYear
Date
Age
Does this child have any allergies?
If you selected Yes, please list all allergies
If you selected No, type "None"
Response to allergic reaction (Select all that apply)

Other
Any special needs, sensory considerations, or information we should know? (this information will be kept confidential and only shared with staff who will be working with this child)
If not applicable, enter "N/A"
If you need to register more than 3 children, please complete this form and then start a new registration for the 4th or more children.
Assigned Session Time (Guests Can Not See This Field - Staff Facing Only)
(example: 1:00-1:30pm)
Approved to Pay? (Guests Can Not See This Field - Staff Facing Only)
Only change this to "Yes- Send Invoice" after you have confirmed there is an open spot for the child.
Session Preference (Not guaranteed, but we'll try!)
If registering multiple children, how would you prefer sessions be assigned?
Emergency Contacts

When possible, please list people who are local. (Example: You list your best friend instead of your child's grandmother, because grandmother lives out of town.)
Emergency Contact #1 - First and Last Name
Relationship to child (or you)
Emergency Contact #1: Phone Number Including Area Code
Emergency Contact #2 - First and Last Name
Relationship to child (or you)
Emergency Contact #2: Phone Number Including Area Code
Activity Permissions
I give permission for my child/children to participate in:
Please list any activities your child/children may NOT participate in
If there are no restrictions on your child/children participation, type "N/A"
PARENT AUTHORIZATIONS AND RELEASE OF LIABILITY
To the best of my knowledge this information is correct, and the individuals herein described have permission to engage in all Kids Care activities unless restrictions are noted.
Assumption of the risks and release. I, in my legal capacity as the parent/guardian of the minor(s) named herein, do hereby acknowledge and agree that participation in The Playful Pop Up activities comes with inherent risks. I have full knowledge and understanding of the inherent risks associated with The Playful Pop Up participation, including but in no way limited to: (1) slips, trips, and falls, (2) injuries, (3) athletic injuries, and (4) illness, including exposure to and infection with viruses or bacteria. I further acknowledge that the preceding list is not inclusive of all possible risks associated with The Playful Pop Up participation and that said list in no way limits the operation of this Agreement. I further certify that the named minor(s) are in good health and have no conditions or impairments which would preclude their safe participation in The Playful Pop Up activities, and I hereby release The Playful Pop Up, it's employees, owners and affiliates from any and all liability and indemnification associated with the aforementioned risks.
Realizing that a sudden illness or accident may happen to a child in our care, I hereby ask the staff of the Playful Pop Up to use their best judgment in such cases in caring for my child/children. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by The Playful Pop Up to secure and administer treatment, including hospitalization, for my child/children. I authorize The Playful Pop Up to provide or arrange necessary transportation for my child/children. I further understand that Kid Care fees do not include accident or illness insurance and The Playful Pop Up, it's employees, owners or affiliates are not responsible for any expenses incurred and I agree to release any records necessary for insurance purposes.
I give permission for use of my child/children in promotional photographs and/or videos including The Playful Pop Up web page and social media sites utilized by The Playful Pop Up. My child may be interviewed, photographed and/or video taped by the news media, including newspapers, magazines, television and/or radio for community interest stories and advertising.
I give permission for my child to have sunscreen applied.
If needed, I give permission for staff to place my child in a 2 minute time out for repeated unkind or aggressive behavior. I understand that if my child's behavior is disruptive and cannot be improved with gentle reminders, I may be required to return and check my child out of Kid Care. I understand and agree that I will not receive a refund for these situations, however, staff may issue me a raincheck if they decide it is appropriate. I understand that the decision is at the sole discretion of the staff of The Playful Pop Up.
If The Playful Pop Up closes due to circumstances outside of its control (including but not limited to: weather, injury, illness; I understand that I will not receive a refund, but I will receive a rainchecks to be used at a future date, as space allows. I understand that all purchased sessions must be used within the same weekend.
I have read and understand that there is a $5 per minute charge for every minute I am late picking up my child. (if you are in line to pick up your child, that is not considered late.)
I understand that if I am texted or called, I have 5 minutes to return to the check in desk at Kids Care to assist my child. I understand that under no circumstances will an employee of The Playful Pop Up assist my child in the porta-potty. I understand that no staff member will enter the porta potty with my child. I understand that there is a $25.00 fee if I do not show up to assist my child in the porta potty (if I receive a text/call requesting I return to assist my child).
I understand that food and drink of any kind is not allowed in Kids Zone or Kids Care due to the safety of children with life threatening allergies. I understand that the only beverage allowed in Kids Care is purified water, supplied by The Playful Pop Up. (To ensure the safety of all children)
I understand that I must stay on the property of The Playful Pop Up Market for the entire length of my child's play session. I understand that I am not allowed to leave the property or parking lot without first checking my child out of Kids Care. I consent to receive text messages or calls from The Playful Pop Up and I understand that I must keep my cell phone on my person and pay attention to any text or phone calls that I receive from The Playful Pop Up while my child is attending a play session.
I understand that it is my responsibility to inform The Playful Pop Up of any medically necessary information required to adequately care for my child during their play session. I understand that if my child requires an Epi Pen or other medical device for their safety, that I have given the device or EpiPen to the check in staff member and instructed the staff of The Playful Pop Up on how to use said device or Epi Pen. And additionally, I give my consent to allow them to administer this device or Epi Pen, in the event it becomes medically necessary, or in the event the staff believes my child's life is in danger and must administer the device or EpiPen. If I do not consent to leaving this device or Epi Pen with the staff of The Playful Pop Up, I understand and agree that the staff of The Playful Pop Up will make all reasonable effort to contact me so that I can return immediately to assist my child. I acknowledge and agree that I will not hold The Playful Pop Up or it's employees, owners or affiliates, responsible for the illness, injury or death of my child in the event of an allergic reaction or medical event requiring said device or Epi Pen.
These authorizations and policies constitute the full understanding of the parties hereto and no change, modification or waiver of any of these policies shall be effective unless in writing and signed by both parties.
By typing your name below you are stating that you agree to the above text.
Signature of Parent / Legal Guardian
Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Signature

Parent/Guardian Signature
Parent/Guardian Printed Name
Registration Status
QR Code
QR Code
Payment Status
Should be Empty:

The Playful Pop Up

Kids Zone Registration & Parent Waiver

Child Registration

Additional Child Registration

If you need to register more than 3 children, please complete this form and then start a new registration for the 4th or more children.

Session Preference (Not guaranteed, but we'll try!)

Emergency Contacts

Activity Permissions

PARENT AUTHORIZATIONS AND RELEASE OF LIABILITY

Signature of Parent / Legal Guardian