SHOPPING FOR KNOWLEDGE, INC EXPRESS LEARNING CARE FORM
WELCOME! WE ARE DELIGHTED TO BE YOUR NEW REVOLUTIONARY FUN LEARNING SUPPORT SYSTEM!

Below is our Express Learning Childcare Drop-Off Intake Form for Potty Trained Children 2 and up!

A Learning "Play Volunteers" is a Person Who is 10 Years or Older and is Free with a Paying Sibling!

This Form Is to be Completed by a Parent/Guardian Over the Age of 18

Express Learning Care Cannot Exceed 10 hrs per wk.

(Service animals are welcome! Yes, bring a snack! Reminder: We are a peanut free-environment)

Wavier and Liability Release *
Required
Welcome to Shopping for Knowledge!
Shopping for Knowledge Four Seasons of Learning!
Today’s Care Parent Guardian Name and Contact Number (*Please indicate if a different person is picking up and print name) *
Your answer
Person Droppping Off Driver's Licence Number *
Your answer
Please Indicate Session Date of Drop-Off Session. *
MM
/
DD
/
YYYY
Please Indicate the Drop-Off Time *
Time
:
Please Indicate Session Time Pick-up Time. *
Time
:
Special Needs, Allergies or Special Instructions *
Your answer
Child's or Children's Name and Age *
Your answer
Address *
Your answer
Parent Email Address (To receive Fun Updates!) *
Your answer
Emergency Contract Name and Phone Number *
Your answer
Email Address *
Your answer
Rules and Regulations
This form permits the use of the entire tutor floor and all of our play tools including the following play interactions of Body Sock Play, Heavy Weight Play, Trampoline Play, Sit and Spin, Mountain Climb and all of the other fun items at Shopping for Knowledge as needed to engage in express learning care fun!

Your child must be potty trained- No diapers will be changed by staff.

Children will learn at own pace. We have permission to take pictures of children with their faces for marketing and promotional purposes.

For your child’s security, the person who signed the child in must also sign the child out unless prearranged pickup is discussed in person, text, or on the intake form.

We will assist your child from the store and mall should an emergency arise. (Please visit our website for entire emergency procedures at Shopppingforknowledge.com under the "learn more" tab.)

10 hours per week or less of learning including attending combo tutor learning sessions
There is a five dollar every 15 minutes over the closing sessions.
Marking the below tab on this registration form acknowledges acceptance of rules today and future visits.


Waiver and Release of Liability

In agreeing to receive care provided by Shopping for Knowledge Tutor Shop and to use the facilities and Body Sock, Heavy Weight and Trampoline and all other learning tools and items that may be choking hazardous while doing business as tutoring and express learning care located at 3800 East Main Street
St. Charles, Il 60174

I agree as follows:

I fully understand and acknowledge that (a) the activities in which my child will engage in is a part of the
Tutoring practice provided by Shopping for Knowledge therapy play activities and equipment
that my child may use as a part of the tutoring session may have inherent risks, dangers, and hazards and such exists in the use of any equipment and my child’s participation in these activities; (b) my child’s participation in such activities and/or use of such equipment may result in injury or illness including, but not limited to bodily injury, disease, strains, fractures, partial and/or total paralysis, death or other ailments that, could cause serious disability; (c) these risks and dangers may be caused by the negligence of
the representatives or employees of Shopping for Knowledge; the negligence of the participants, the negligence of others, accidents, breaches of contract, or other causes. By my child’s participation in these activities and for use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and/or damages whether caused in whole or in part by the negligence or the conduct of the representatives or employees of Shopping For Knowledge, or by any other person.
I, on behalf of myself and my child, and as my child’s personal representatives and my heirs, hereby voluntarily agree to release, waive, discharge, hold harmless, defend, and indemnify Shopping for Knowledge and their representatives, employees, and assigns from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my use of any equipment or participation in these activities. I specifically understand that I am releasing, discharging, and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the representatives or employees of Shopping for Knowledge.

I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE. IT IS MY
INTENTION TO EXEMPT AND RELIEVE SHOPPING FOR KNOWLEDGE FROM LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.

Print this form and bring it to Shopping for Knowledge, Inc registration desk for Express Learning Care!

Signature Indicates Acceptance of Rules and Regualtions *
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