In case of an emergency, notify: (List contact information for hours during Day Care -for example work address and phone if at work)
Names of individuals authorized to pick up child who are NOT listed above:
The following information must be filled in by the parent/guardian. The intent of this information is to provide staff the background to provide appropriate care. Provide complete information so that we can be aware of your child's needs.
Allergies / Describe reaction and management of the reaction
By submitting this form, I agree to abide by the rules and regulations set forth by Home Beneath Our Feet staff members. I hereby give permission for Home Beneath Our Feet to use for promotional purposes any photos or videos taken of my child while involved in this program. By signing my name below, I am indicating that: this registration form is correct to the best of my knowledge and that child herein described has permission to engage in all prescribed activities except those noted by me. I understand that Home Beneath Our Feet activities have inherent risks and I hereby assume all risks and hazards incident to my participation in all Home Beneath Our Feet activities. I further waive, release, absolve, indemnify, and agree to hold harmless Home Beneath Our Feet, the organizers, volunteers, supervisors, officers, directors, participants, coaches, referees, as well as persons or parents transporting participants to and from activities from any claims or injury sustained during my participation in Home Beneath Our Feet activities.