Learning through Play ™ Registration Form   
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RELEASE OF LIABILITY

THIS AGREEMENT is made on between EB Pediatric Resources, Inc. (“Provider”) and the person listed below (“Parent”) who is a natural parent of the Child or the legally appointed guardian of the Child concerning Preschool Program, Playgroups, Developmental Therapy, or other center-based services (“Services”) provided to the Child listed above.

Recitals
WHEREAS, Parent will be entering the Learning Through Play Child Developmental Center (“Center”) located at 633 W Addison Chicago IL 60613 to receive Services and the Parent has retained Provider specifically to render these Services to the Child. Provider has given Parent a full and adequate opportunity to ask questions and obtain a full and complete explanation of the risks of the activity;

PARENT’S RELEASE: This is the certify that I, on my own behalf and on behalf of my child, fully understand that there is risk of personal injury to my child in participating in play-based activities and other physically active games through the programs provided by EbPediatric Resources, Inc. d/b/a Learning through Play™ Child Development Center. I am aware that my child is engaging in physically active games and/or therapeutic play-based activities which could result in his/her injury. I am voluntarily allowing my child to participate in these activities and assume all risks of injury that may result. I personally, and on behalf of my child, agree to hold no individual or corporation responsible or liable for any injuries that my child receives on account of these activities, including but not limited to EbPediatric Resources Inc, or its officers, employees, agents, aides, therapists, instructors, insurers, successors, or assigns (hereinafter “Releasees.”) I further agree to waive any claims or causes of action against and to hold harmless said Releasees for any injuries or damages which my child suffers or might suffer as a result of the conduct of any person during or in conjunction with said physically active games or therapeutic play-based activities. EbPediatric Resources Inc and its officers, employees, subcontractors, agents, therapists, aides, or instructors will make no formal evaluation whether my child is sufficiently fit for any exercise or activity. I agree that my child is able to participate in a therapeutic play-based physical activities program and that it will not be detrimental or inimical to his/her health, safety, comfort, or physical condition and that of others if he/she participates in said activities.

POLICY AGREEMENT

NOW, THEREFORE, in consideration of the Parent retaining Provider to provide Services to the Child in the Center, the parties agree that:

• Parent or a Caretaker selected by Parent shall be present during all times that Services are provided.
• Parent shall agree to abide by the Center’s rules:
• Payment and a completed liability release form are required to attend.
• Leave sick children at home. Do not bring infectious children to Center.
• Keep strollers away from the doors. The doors are our fire escape.
• Caregivers must accompany and supervise their children at all times.
• Caregivers must clean up after snacks and spills. Be careful with hot beverages.
• Monitors reserve the right to ask those acting inappropriately to leave for that day.
• During the term Services are provided and for a period of 6 months thereafter, Parent will not offer to employ any employees or independent contractors of Provider without the prior, written consent of Provider and for a fee acceptable to both parties to fairly compensate Provider for the loss of any such employee or independent contractor and the cost of hiring another in his or her place.
• Tuition Policy: I understand that the registration fees must be paid in full prior to the start of class/services. I also understand that these fees are NON-REFUNDABLE.
• Cancellations: I understand that credits will not be issued for cancellations for any reason. Make-up classes are not allowed as part of this policy but one make-up per series may be at the discretion of the instructor as a courtesy. I understand that if my child is absent more than three sessions in any one series, EbPediatric Resources reserves the right to refuse re-admittance to the programs.
• Illness: I understand that if my child is ill, he/she will not be allowed to participate in the class.
• Diaper-changing: There is a diaper-changing facility onsite but all supplies (diapers, pull-ups, wipes, ointments) must be provided by the parent.
• All children must wear socks in the gym area as is recommended by state health standards.
• Food Allergies: I understand that snacks may be served to children during longer classes and may contain sugar. I understand that it is the parent’s responsibility to inform EBPediatric Resources and its staff if my child has a restricted diet or specific food allergies.
• Media/Research: I understand that publicity photos (for use in promoting Learning through Play or other activities of EbPediatric Resources) may be taken within the facility. Your signature on this agreement constitutes a full release including relinquishing rights to receipt of gratuities or royalties immediately or in the future. All photos or other materials remain the property of EbPediatric Resources Inc. In addition, your child’s class or therapy session may be observed by visiting parents, graduate students, or other professionals. Your signature on this agreement constitutes your permission for this observation and full release.