LELA Registration and Liability Form

LELA Registration and Liability Form

Please complete this form to provide required consent and release of liability for your child’s participation. Once your registration is approved you will be emailed a payment form.
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Email Address
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child's Full Name

First NameLast Name
Child's Age
Child’s Date of Birth

MonthDayYear
Date
Which class are you registering for? (you can select both)
Medical Information
Any allergies or important medical information
In the event of an illness, injury, or medical emergency involving my child while participating in a LELA program, and if I or my designated emergency contact cannot be reached promptly, I authorize LELA and its representatives to seek appropriate emergency medical care for my child, including transportation to a medical facility if deemed necessary.

I understand that every reasonable effort will be made to contact me or my emergency contact before medical treatment is provided. I acknowledge that I am financially responsible for any medical expenses incurred as a result of emergency treatment provided to my child.

I understand that participation in LELA activities involves ordinary risks associated with children's educational and play-based programs. I voluntarily assume these risks on behalf of my child and release, waive, and hold harmless LELA, its owner, employees, volunteers, and representatives from liability for injuries, losses, or damages arising from participation in LELA programs, except to the extent caused by gross negligence or willful misconduct.

By signing below, I acknowledge that I have read, understand, and agree to this Emergency Medical Authorization and Liability Agreement.
Bathroom Independence Policy: Teachers and staff are not allowed to assist students in the bathroom in any way. Students must be fully independent in the bathroom, including toileting and hand washing, as a condition of participation. Parents and guardians must acknowledge and agree to this policy in order for their child to attend the class.
Media Release Consent
Policy Information
Parent remains responsible until check-in.
Authorized pickup persons must be listed and approved in advance.
Illness policy: children should not attend when sick or showing symptoms of illness.
Behavior expectations: children are expected to follow class rules and staff directions.
Child may be removed if behavior creates a safety concern.
Parent/Guardian Signature
Date

MonthDayYear
Date
Should be Empty:

LELA Registration and Liability Form

Medical Information

Policy Information