Bloom Kids Club Registration and Waiver
Kids Club is Bloom's drop off play service for children, potty trained and up*, that provides supervised play without parent/caregiver remaining on premises. Kids Club is available during regular open play hours.

This agreement must be completed in full for each child (“Participant”), and have the signature of a parent or legal guardian before s/he may participate Bloom Kids Club. The standard Bloom full waiver/consent form must be on file for Participant in addition to this Kids Club form. All rules and conditions outlined in the Bloom waiver/consent form apply during Kids Club.

Kids Club Policies:

Care is provided at a 1 staff: 3 children max ratio. Care must be reserved at a minimum of 24 hours in advance (more advance notice is preferred to ensure we can prepare to accommodate your request). Minimum time for care is 1 hour; maximum 3 hours*. All time will be rounded up to the nearest next hour; no partial hours are calculated.
Non-refundable deposit for the first hour is required within 24 hours of requested care day and time (pending extenuating circumstances such as weather or illness).

Rates:

Non-members
1st hour: $15; Subsequent hours: $5. Siblings are $5 an hour additional flat.

Members
1st hour: $10; Subsequent hours: $5. Siblings are $5 an hour additional flat.

Kids Club includes open play for the remainder of the day should parent wish to stay and play longer after pickup.

*Accommodations for non-potty trained children or extended hours is possible on an individual basis, depending on staff availability but details must be discussed and agreed upon ahead of time.
Email address *
Child's Information
One form may be used for multiple children of the same family and multiple dates. Upon receipt of your form, we will contact you if we have any questions.
Child's Full Name (First and Last) *
Your answer
Child's Age *
Your answer
Are there any special notes regarding this child (allergies, considerations)? *
Your answer
What day(s) would you like to register your child for Kids Club? *
Your answer
What is the drop off time and planned pick up time? (3 hour max. All charges are rounded up to next hour) *
Your answer
Parent/Guardian Information
Parent/Guardian Full Name (First and Last) *
Your answer
Primary Contact # where you can be reached while your child is at Bloom Kids Club *
Your answer
Emergency Contact Name in case you cannot be reached *
Your answer
Emergency/Alternate Contact Phone # *
Your answer
Waiver and Release of Liability
As a parent or guardian of Participant, I hereby release Bloom Waldessori Play Space, LLC and all of its agents, employees, officers, and directors from any and all risks, actions, causes of action, claims, demands, liabilities and obligations of any and every nature whatsoever, including, without limitation, for illness, personal injury, death, property damage, and personal or proprietary rights, and hereby hold Bloom Waldessori Play Space harmless and agree to fully indemnify Bloom Waldessori Play Space from and against any and all claims. I hereby personally assume full responsibility for any and all claims and for any and all hospital and medical bills for myself and/or participant.

I authorize Bloom staff to assist with child's restroom usage either at the request of myself or the child. I authorize Bloom staff to administer basic first aid if needed. In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize Bloom staff to make a determination to request EMS at my expense.
Electronic Signature
I am the parent/guardian of the child(ren) listed on this form (Participant), who is/are under 18 years of age, whom I am registering as a Participant in Bloom Kids Club. I certify that I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.
Please type your First and Last Name (Electronic Signature) *
Your answer
Today's Date *
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