Thrive Kinder Prep

Registation form


Child's Name Parents Name Parents Name
Who else is has permission to pick up your child?
In case of emergency, I give permission for any of the following individuals to be contacted and my child to be released to any of them. Child's Health Information Waiver and Release of Liability Agreement The undersigned hereby represents that he or she is the parent or guardian of and agrees to the following: I understand and agree to a full and complete waiver and release of any and all liability ("Liability Release") on the part Thrive in connection with my Child's attendance at Thrive and participation in all of its activities, including, but not limited to, playground activities, classroom activities and field trips take in connection with Thrive. I understand and agree that this Liability Release will apply to the entire duration of my Child's attendance at Thrive and participation in all of its activities. I further authorize anyone working at Thrive to obtain medical care for my Child or transport my Child to a clinic or hospital if, in the opinion of anyone working at Thrive, medical attention is needed for my Child. I agree that if Thrive releases my Child to me, my designee, an ambulance or other medical transport, a medical facility, a clinic or hospital, that Thrive staff shall not have any further responsibility for my Child. I agree to pay all costs associated with such medical care and related transportation for my Child and indemnify and hold Thrive, its representatives and agents harmless from any cost incurred in connection with such medical attention or any related claims. This Liability Release may only be revokable in writing that is signed by both myself and the Director of Thrive. I acknowledge that I have carefully read this Liability Release and understand its contents. Photograph Release Agreement With my signature below I grant permission for my child(ren) to be photographed, or their images recorder for print or electronic use in promoting the services. I understand that it is my responsibility to update this form in the event I no longer wish to authorize the above uses. I agree that this form will remain in effect during the term of my child's enrollment. I understand that there will be no payment for my or my child's participation in this release. I authorize my child's photo to be taken:

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Signature Certificate
Document name: Registation form
lock iconUnique Document ID: 8ac181de554a9059de820246b2f59854e974be51
Timestamp Audit
October 25, 2019 7:01 am PDTRegistation form Uploaded by Samantha McKeon - thrivekinderprep@gmail.com IP 23.242.128.140
October 29, 2019 4:02 pm PDTThrive Kinder Prep - thrivekinderprep@gmail.com added by Samantha McKeon - thrivekinderprep@gmail.com as a CC'd Recipient Ip: 23.242.128.140
October 29, 2019 4:06 pm PDTThrive Kinder Prep - thrivekinderprep@gmail.com added by Samantha McKeon - thrivekinderprep@gmail.com as a CC'd Recipient Ip: 23.242.128.140
October 29, 2019 4:06 pm PDTThrive Kinder Prep - thrivekinderprep@gmail.com added by Samantha McKeon - thrivekinderprep@gmail.com as a CC'd Recipient Ip: 23.242.128.140
October 29, 2019 4:09 pm PDTThrive Kinder Prep - thrivekinderprep@gmail.com added by Samantha McKeon - thrivekinderprep@gmail.com as a CC'd Recipient Ip: 23.242.128.140
October 29, 2019 4:10 pm PDTThrive Kinder Prep - thrivekinderprep@gmail.com added by Samantha McKeon - thrivekinderprep@gmail.com as a CC'd Recipient Ip: 23.242.128.140
October 29, 2019 10:45 pm PDTThrive Kinder Prep - thrivekinderprep@gmail.com added by Samantha McKeon - thrivekinderprep@gmail.com as a CC'd Recipient Ip: 23.242.128.140