Child Care Contact/Waiver/Info
Essential Businesses/Worker Form (PEOPLE WHO FEEL SICK SHOULD STAY HOME)
Guidelines for Individuals: • You have not been sick or know of anyone being sick. Upon entering the building you are required to be 6 feet apart and get a Temperature Check and Wash Hands. You and your child will avoid touching your face and sneeze or cough into a tissue, or the inside of your elbow. Shoes/Equipment Disinfectant Area Available. Consider using face coverings while in facility. (Available at front additional cost) Capacity is 3 participants per 1000 SF *
Parent/Guardian/Adult *
Parent(s) Name (FIRST) *
Parent Name (LAST) *
Child(s) FIRST & LAST Name (Used for Check In) or Self *
Email(s) (Separated by commas) *
Street Address *
City/State *
Zip Code *
Emergency Phone number(s) *
Child Care Option *
Essential Businesses/Sector *
Read Waiver/Information Below *
Waiver Details
No child will share equipment or items brought from home. The building is 28,000 SQ F and ratio of kids will be less than 2 per 1000 Square feet.

Placer County Definition of Essential Businesses:
Childcare facilities providing services that enable owners, employees, volunteers, and contractors for Essential Businesses or Essential Governmental Functions, Stage 2 Retail to work as permitted. Children of owners, employees, volunteers, and contractors who are not exempt under this Order may not attend childcare facilities.
Covid-19 Concerns and Waiver
We understand the sensitivity of today’s changing climate and our facilities have been cleaned and disinfected with a recommended CDC Solution to minimize risks of the COVID-19 Pandemic and will operate on a minimum basic operations.

My child will practice 6 feet of social distancing when feasible. Information may change per week and based on state recommendations.

No one in my family is sick and I willingly don't know anyone sick. I understand that my child may be sent home if he shows symptoms of sickness. My child has washed his hands prior to entering the facility. This waiver also serves as notice there is some reasonable risk and I waive release liability of parents, instructors, Youth Basketball Academy, Hardwood Palace, Synegy Sports Association, Galilee Real Estate and Aron Schapiro.

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