Please Read Before Signing

 

 

I _____________________________________________________, the undersigned (legal guardian) of

 

______________________________________________ (child/children), hereby execute this Participant Agreement that will govern my participation in Grace Place Playgroup at a facility owned by Grace Episcopal Church.

 

This Agreement is intended to permit Grace Episcopal Church to allow my child to participate in Grace Place Playgroup. When I refer to ŇGrace Episcopal ChurchÓ in this document, I refer to the Church itself, its employees, designated Parent Volunteers, and all persons authorized by the Church to act in any capacity with regard to the Playgroup.

 

I hereby acknowledge that Grace Place Playgroup is a cooperative program between the Church and Playgroup Participants. It is a permitted use of the Church facility and permission for my chosen Parent Volunteers to manage Playgroup funds and activities on my behalf. I understand that I am entirely responsible for my childŐs participation in Playgroup activities, supervision, compliance with rules, food choices, use of facilities/equipment, and cleanup.

 

I hereby acknowledge that activities of Grace Place Playgroup on any given day shall be determined by participating caregivers, and that all altercations or disagreements will be handled by the caregivers and not by Parent Volunteers.

 

I agree that my child will be accompanied by his/her caregiver at all times, and understand that my childŐs ongoing participation in the Playgroup may be immediately terminated if a caregiver is not present as his/her chaperone.

 

I agree to be responsible for my childŐs behavior at all times, and agree to abide by the decision, on any given day, of a Parent Volunteer, that my child must leave due to behavior, perceived illness or other factor.

 

I hereby acknowledge that there may be risks to the personal safety of my/our son/daughter. In order to induce Grace Episcopal Church to allow my/our child to participate in Grace Place Playgroup I hereby release Grace Episcopal Church from any liability or responsibility in regard to his/her personal safety.

I hereby release and discharge Grace Episcopal Church from any and all liability, claims, demands, settlement, judgments or causes of action that I may hereafter have for injuries or damages arising out of our childŐs participation in Grace Place Playgroup.  I further agree that I will not sue or make claim against Grace Episcopal Church for damages or other losses sustained as a result of our childŐs participation in Grace Place Playgroup.

 

I also agree to indemnify and hold the Church harmless from all claims, judgments and costs, including but not limited to attorneysŐ fees, and to reimburse them for any expenses whatsoever incurred in connection with an action brought as a result of our childŐs participation in Playgroup activities.  This hold harmless shall not apply to injuries or damages arising out of the sole negligence of Grace Episcopal Church, its officers, directors, and employees or authorized agents.

 

I have read and I agree to abide by all rules and directives of Grace Episcopal Church in relation to my childŐs participation in Grace Place Playgroup.

 

 

____________________________________________________________________

Parent/Guardian                                                                      Date

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Name(s) and date(s) of birth:

 

_______________________________________________________________________

 

_______________________________________________________________________



Name of parent/caregiver: ________________________________________________

 

Address: ____________________________________________________________

 

 

Daytime Phone: _________________________ Home Phone Number:  ______________________

 

 

Emergency contact name and number:_________________________________________________

 

 

E-mail: _______________________________________________________________

 

I/WE give permission for my information to be included in a Grace Place parents contact sheet

for purposes of sharing child-oriented events and information (please check): Yes_____ No_____

 

I/We will participate in the following toy wash(s).  Each toy wash will begin at 7:00 p.m.

 

______Wednesday, Feb 8             ______Wednesday, Mar 14  _______Wednesday, Apr 25         

 

I/We will volunteer for the following:  Person in charge – available on site for full session, open – need to be there no later than 9:15 a.m. to unpack toys and set about; close need to start closing at 11:30 a.m. and ensure all is put away before leaving building.  Volunteers receive 25% discount on registration fees.

 

_____ Mon. person in charge         _____ Mon. open      _____ Mon. close   

 

_____ Thurs. person in charge       _____ Thurs. open    _____ Thurs. close

 

Fees: 

 

_____$270     Registration fee for first child in family enrolled

 

_____$65      Registration fee per child for each sibling enrolled (siblings under 6 mos free)

 

_____$60      Toy Wash (per family if unable to participate in a Toy Wash session)

 

_____$ Total  (deduct 30% is you are a parent/nanny volunteer)

 

Questions or comments may be directed to:  playgroup@gracechicago.org

 

For Office Use Only

Payment Received:_____________________________________________________

(Please fill out both sides of form)

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