FORT GREENE CLINTON HILL PLAYGROUP, INC. WAIVER OF LIABILITY
As a condition to my child(ren) participating in the FCGH Playgroup, by signing this Waiver, I acknowledge and agree that:
________ 1. I am the parent/legal guardian of the child(ren) named on this form. I give permission and accept full responsibility for the child(ren) to participate in the FGCH Playgroup at Lafayette Avenue Presbyterian Church (the “LAPC Facilities” or “LAPC”). “I,” “me,” “my,” and “parent(s)” mean the parent/legal guardian or such person’s representative, including, but not limited to, any caregiver, family member, babysitter or nanny.
________ 2. The child(ren) and I are solely responsible for deciding whether or not to play on or use the structures and other items at the LAPC Facilities, within any guidelines or rules of the LAPC Facilities or the FGCH Playgroup. It is not the FGCH Playgroup’s responsibility to monitor the safety or behavior of the children and/or adults at the FGCH Playgroup, however the FGCH Playgroup may request that an adult and/or child(ren) leave the LAPC Facilities or FGCH Playgroup playtime temporarily or permanently based on, but not limited to, FGCH Playgroup’s concern for safety or expected behavior.
________ 3. I assume full responsibility for and risk of bodily injury, death, property damage or loss, regardless of severity, that I or my child(ren) may sustain from me or my child(ren)’s participation in or presence at the FGCH Playgroup or LAPC Facilities.
________ 4. Parents assume full responsibility for the conduct, supervision, and safety of their child(ren) at FGCH Playgroup. Parents agree that they shall remain on the premises and responsible for their child(ren) at all times.
________ 5. I agree to indemnify and save and hold harmless FGCH Playgroup from any loss, liability, damage or cost they may incur due to me or my child(ren) participating in the FGCH Playgroup.
________ 6. I hereby give permission for my child(ren) or me to be transporte d should an emergency situation arise.
NOTICE OF LEAD PAINT & WAIVER OF LIABILITY
________ 1. I acknowledge and understand that lead paint is a hazardous substance that has been shown to cause severe health problems, including mental retardation, especially in children under six years of age. Children and women who are pregnant, nursing, or planning to become pregnant should avoid exposure to lead paint.
________ 2. I acknowledge and understand that, following lead testing activities, a lead paint hazard was previously identified at the LAPC Facilities. I further acknowledge and understand that remediation of the lead paint hazard has been completed, that the LAPC Facilities have been certified as lead -safe, and that a copy of the certification is available to me on request.
________ 3. I acknowledge and understand that the FGCH Playgroup has undertaken to maintain the LAPC Facilities in a lead-safe condition and has indemnified the LAPC against a potential claim relating to lead contamination of the LAPC Facilities by or on behalf of children participating in programs operated by the FGCH Playgroup.
________ 4. I, for myself and all of my child(ren), expressly and specifically assume the risk of any injury or harm relating to lead contamination of the LAPC Facilities.
________ 5. I, for myself and all of my child(ren), forever waive any and all claims against LAPC and the FGCH Playgroup for lead contamination injury.
________ 6. I, for myself and all of my child(ren), agree to forever hold harmless and indemnify LAPC and the FGCH Playgroup from any and all loss and expense relating to claims against LAPC for lead contamination injury to any of myself or my child(ren).
________ 7. THIS AGREEMENT APPLIES TO ALL PAST, PRESENT AND FUTURE VISITING AND USES BY ME AND MY CHILD(REN) TO THE FGCH PLAYGROUP. I AGREE with, have read, understand and am legally competent, of legal age to give this acknowledgement and release and to execute this Waiver, which shall be legally binding on me and my child(ren) and our personal representatives, executors, heirs and assigns.
AGREEMENT TO PARTICIPATE
As a condition to my child(ren) participating in the FCGH Playgroup, by signing this Agreement to Participate , I acknowledge and agree that:
1. All parents are expected to participate in the clean-up time(s) specified at the time of registration.
2. A child’s parent must remain on-site and supervise his/her child at all times while his/her child(ren) is/are at FGCH Playgroup.
3. All parents are expected to respect the start/end times of their enrolled session(s). No parents or children are permitted to remain in the play space after 1:30pm.
4. For the well-being of other children and adults, do not bring sick children or sick adults to the FGCH Playgroup. Any child or parent with a fever, green/yellow mucus, diarrhea, or vomiting should not attend the FGCH Playgroup until their symptoms have cleared.
5. Any child or parent with lice or nits should not attend the FGCH Playgroup until they are completely nit-free.
6. All parents are expected to read and follow any and all signs posted at LAPC Facilities.
7. All parents are expected to contribute to keeping the play areas clean, tidy, and organized, whether or not they or their child(ren) made the specific mess. This includes the bagging and removal of ALL playgroup trash to the shared church entryway at the termination of the afternoon session.
8. Snacks and sippy cups are not permitted in the main play areas at any time. Children may participate at group snack during the prescribed time during each session, or else may eat/drink while supervised to the side of the play areas.
9. Playgroup is nut-free. Please do not bring nut products into the facilities. Further, we ask all parents and caregivers to be mindful of allergies, and to be accommodating if another parent/caregiver expresses that their child has a particular allergy.
10. If a child displays a behavioral concern(s) (such as, biting, hitting, pushing, hair pulling, etc.), they may be asked to leave and/or not return to Playgroup, with no refund of monies paid .
REPRESENTATION OF CHILD IMMUNIZATION STATUS
I hereby represent and warrant that my child(ren) is/are fully up to date on his/her/their immunizations as mandated by New York Public Health Law Section 2154 (see below). Further, I hereby affirm that my child(ren) will remain fully up to date on all immunizations for the duration of his/her time enrolled in the Fort Greene Clinton Hill Playgroup Inc. If there comes a time whereby my child(ren)’s status changes, I will notify the Coordinator of this change prior to my child attending Playgroup. I understand that any change in my child(ren)’s immunization status may result in exclusion from Playgroup going forward. I acknowledge that this form will not be stored securely and I agree that FGCH playgroup and/or its members/coordinators are not responsible in the event that this form is accessed by a third party. Public Health Law Section 2154 (PHL § 2154): “Every person in parental relation to a child in this state shall have administered to such child an adequate dose or doses of an immunizing agent against poliomyelitis, mumps, measles, diphtheria, rubella, varicella, Haemophilus influenzae type b (Hib), pertussis, tetanus, pneumococcal disease, and hepatitis B, which meets the standards approved by the United States public health service for such biological products, and which is approved by the department under such conditions as may be specified by the public health council.”
PLAYGROUP POLICIES
1. At least one member of each registered family must participate in one clean-up night per semester. In the event that no one from a participating family can attend they can send a proxy.
2. A child’s parent/caregiver must remain on-site and supervise his/her child(ren) at all times while his/her child(ren) is/are at Playgroup.
3. All parents/caregivers are expected to respect the start/end times of their enrolled session(s). No parents/caregivers or children are permitted to remain in the play space after 1:30pm.
4. For the well-being of other children and adults, do not bring sick children or sick adults to Playgroup. Any child or parent/caregiver with a fever, severe running nose, diarrhea, or vomiting should not attend the FGCH Playgroup until their symptoms have cleared.
5. Any child or parent/caregiver with lice or nits should not attend Playgroup until they are completely nit-free.
6. All parents/caregivers are expected to contribute to keeping the play areas safe, clean, tidy, and organized, whether or not they or their child(ren) made the specific mess. This includes the bagging and removal of ALL playgroup trash to the shared church entryway at the termination of the afternoon session.
7. Snacks and sippy cups are not permitted in the main play areas at any time. Children may participate in group snack during the prescribed time during each session or may eat/drink while supervised in the snack area.
8. Playgroup is nut-free. Please do not bring nut products into the facilities. Further, we ask all parents and caregivers to be mindful of all other allergies (most commonly dairy), and to be accommodating if another parent/caregiver expresses that their child has a particular allergy.
9. If a child displays behavioral concerns (such as, biting, hitting, pushing, hair pulling, etc.), they may be asked to leave and/or not return to Playgroup, with no refund of monies paid.
10. Adults are not permitted to wear outdoor shoes in the playroom. (Indoor slippers are permitted.)
11. All children must be fully up to date on their vaccinations or else provide a medical exemption. (Religious exemptions are not permitted.)
12. We do offer drop-in packs on our website. Public drop-in packs are $75/5 drop-ins. Registered families receive a discount.
13. Fort Greene Clinton Hill Playgroup (FGCH Playgroup) occasionally uses photographs and/or video of patrons in its web and social media sites without further consideration or notification. By enrolling my child in FGCH Playgroup, I grant FGCH Playgroup permission to use still photographs or video images of me, my child or my caregiver (“Personal Images”). I acknowledge FGCH Playgroup’s right to crop or treat the Personal Images at its discretion. I understand that while a Personal Image may not be used at this time, it may be used at a later date. I also understand that once a Personal Image is posted on the Internet, the image can be downloaded.
14. If there are any issues that arise in session at Playgroup, parents and caregivers are able to speak with our On-Site coordinator Ashley Jossell. Alternatively, parents and caregivers are welcome to reach directly to the FGCH Playgroup Board via email info@fgchplaygroup.org.