Open Gym - Tuesday, September 25 - 9:30-10:30 AM
Play2learn
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Name(s) and DOB(s)) of Child(ren) Attending: *
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Name of Adult Accompanying Child(ren):
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Address:
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City, State, Zip Code:
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Phone Number:
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Preferred Email Address (To receive a copy of this form and monthly newsletter featuring programs/ helpful tips for tots at home)
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Allergies (If multiple children, please indicate child's name and allergies)
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Please type your FIRST and LAST name in the following box agreeing with this consent form. *
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I hereby authorize Play2Learn to take and use photography and/or videography of my child for promotional purposes in any type of media and understand I will not be compensated for any such use. (e.g. "Action shots" at play stations on our FaceBook page, website, or future brochures. We will NEVER use your name or your children's names.) *
Please type your name in the following box agreeing with this consent form *FIRST and LAST name required* *
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I hereby give my consent as the parent/guardian of the above named child/children to attend and participate in the Play2Learn Open Gym Program located at the Baldwinsville location. I hereby release, waive, discharge, covenant not to sue, and hold harmless, Play2Learn, its employees and/or volunteers, from and against any and all liabilities, damages, obligations, losses, claims, causes of action, cost, debts, dues, charges or expenses (including attorney's fees), of whatsoever kind and nature, sustained by or during my child's participation and attendance during this program. *
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