Blue Christmas Child Care
Every child will participate in a story time and craft to follow.
Deadline to register is Dec.10, 2021
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Email *
Child's last name *
Child's first name *
Child's Age 3yr - 12yrs *
Child's Grade (Pre-K 3 - 6th grade only) *
Where does child attend school? *
My child has allergies to the following foods/stings Please list below or put NA if this doesn't apply. *
Emergency Contact Info - Please have emergency contact phone with you while your child is attending. Be advised in case of an emergency on you, the parents part, please call Brandi Sampson at 1-734-770-3448 to alert her of your emergency. Please note if we are trying to contact you, occasionally it may show up as an “unknown" or "private number" or "out of state". *
Please be advised that no nurse will be available. In case of an emergency, 9-1-1 and you will be called. This includes, but is not limited to allergic reactions and asthma attacks. *
LIABILITY Release: If you agree to this Liability Release Form, please include your full name below: I certify that I am the parent/guardian of the student represented in this Registration packet and hereby grant permission for said child to participate in all activities, trips and programs in connection with The CARE Center. Transportation arrangements will be made under authorization of The CARE Center and the trip will be under adult supervision. It is understood that The CARE Center, its employees, volunteers, and adult supervisors assume no liability whatsoever for personal injuries or property damages to said child or to third persons that may occur as a result of said child’s participation in activities at The CARE Center. The undersigned does hereby agree to expressly assume and accept any and all risk of illness, injury, death or property damage in connection with said child’s participation in the activity, trip or program. The undersigned (including its heirs, successors, and assigns) hereby agree to waive, release, discharge, indemnify and will hold harmless The CARE Center from any and all liability claims arising out of or in connection with The CARE Center’s programs and activities including liability arising out of The CARE Center’s negligence. The undersigned acknowledges that completion of this waiver and release agreement is a condition precedent to said child’s involvement in any and all of The CARE Center’s programs and activities. The undersigned further acknowledges that his/her child is physically fit and capable of participating in all such activities. The undersigned further agrees to admonish the child participant to exercise care, to be well behaved and in all things obedient to and under the direction and control of those adults in charge. If you agree to this Liability Release Form, please include your full name below: *
PHOTO/VIDEO RELEASE: I certify that I am the parent/guardian of the student represented in this Registration packet, and hereby authorize The CARE Center and representatives, agents, employees, shareholders, officers, directors, partners, and heirs to use my or my student’s image, photograph or other artwork in one or more of its products, advertising, web page, and promotional material and flyers. I give The CARE Center permission to use, copy or modify such materials for one or more of its products and advertising. I release The CARE Center from any claims or actions of liability that may arise from the use or adaptation of the materials for The CARE Center’s products and advertising. Furthermore, I understand that by signing this contract, I am releasing The CARE Center from any liability for compensation for such materials. BY SIGNING THIS AGREEMENT I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THE TERMS OF THIS AGREEMENT, WAIVER AND RELEASE, AND FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS RELEASE OF LIABILITY IS A CONTRACT BETWEEN MYSELF, MY CHILD, AND THE CARE CENTER. I HAVE FREELY AND VOLUNTARILY EXECUTED THIS AGREEMENT WITHOUT RELIANCE UPON ANY STATEMENTS OR REPRESENTATIONS BY PARTIES OR AGENTS EXCEPT AS SET FORTH HEREIN. *
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