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
I am the PARENT
I am the Guardian
I am a Worker/Volunteer participant over 18
Parent(s) Name (FIRST)
Parent Name (LAST)
Child(s) FIRST & LAST Name (Used for Check In) or Self
Email(s) (Separated by commas)
Emergency Phone number(s)
Child Care Option
Option 1 Non- Contact TV, Movies and Activities
Option 2 Non-Contact Physical Activities (Bring Your Own Equipment)
Option 3 Non-Contact Conditioning-Speed-Agility-Strength
Option 4 Adult-Volunteer Worker
High School Skills/Conditioning
Stage 2 Retail Worker (allowed by the State)
Health and Public Health Sector
Emergency Services/Law Enforcement Sector
Food and Agriculture Sector
Water and Wastewater Sector
Transportation and Logistics Sector
Communications and Information Technology Sector
Government Operations and Other Community-Based Essential Functions
Critical Manufacturing Sector
Financial Services Sector
Defense Industrial Base Sector
Industrial, Commercial, Residential and Sheltering Facilities and Services
Read Waiver/Information Below
I Read Waiver & Information Below
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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