Release of Liability
All precautions will be taken to prevent accidents. However, should an accident occur, first aid will be administered, and parent or doctor will be notified, if necessary. SDC-Studio of Dance and Cheer, LLC and staff cannot be held liable for injuries that occur on premises or otherwise in the care of SDC – Studio of Dance and Cheer LLC personnel.
I/We ___________________________assume all responsibility and waive any claim for compensation for injury incurred by my child while at SDC-Studio of Dance and Cheer, LLC and hereby agree to indemnify or hold harmless its owners or employees against any and all claims which may arise from an injury to my child while participating in the program. I have read and agree to abide by all the guidelines.
Signature of parent or legal guardian ______________________________Date___________
Check all that apply: I hereby ___ give ___ do not give - consent for my child to be transported and supervised by the operation’s employees:
1. ___ Transportation:
___Walk home ___ for emergency care ___ on field trips ___ to and from home ___ to and from school
2. ___ Field Trips: I hereby ___ give ___ do not give - consent for my child to participate in field trips
3. ___ Water Activities: I hereby ___ give ___ do not give - consent for my child to participate in water activities
___ sprinkler play ___ splashing/wading pools ___swimming pools ___ water table play
4. Receipt of written operational policies:
___ I acknowledge receipt of the facility’s operational policies including those for discipline and guidance.
5. I understand that the following meals will be provided to my child while in care:
___ None ___ Breakfast ___ AM Snack ___Lunch ___PM Snack ___ Supper ___ Evening Snack
6. My Child is normally in care on the following days and times:
___ Mondays from: to:
___ Tuesdays from: to:
___ Wednesdays from: to:
___ Thursdays from: to:
___ Fridays from: to:
___ Saturdays from: to:
School Age Children:
___ My child attends the following school
Name of School _______________________________ School Phone #_________________________________________
Check all that apply:
___ His/her immunization record is on file at the school and all required immunizations and/or tuberculosis test are current. Vision and Hearing records.
___ My Child has permission to:
___ walk to or form school or home, ___ ride a bus, and/or
___be released to the care of his/her sibling(s) under 18 years old.
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