Indoor PlayGroup Registration and Liability Release

Date

Parent's First and Last Name

Phone

This address will receive a confirmation email

Address

Names and ages of Children (please include last names if different from above)

Please note special considerations your child may need:

Street Address (if different from above)

Adult other than parent or guardian who may bring the child(ren) to Indoor Playgroup: Name/Relationship

I hereby give permission for my child to be photographed for Indoor Playgroup's use.

Do Do not

The facilities of St. John Lutheran Church are for the purpose of Indoor Playgroup providing an indoor play area for children under the supervision of their parents/guardians. I understand that the general supervision of my child is my responsibility or the responsibility of an adult I have authorized above. I have read and agree to abide by the Indoor Playgroup Guidelines. I understand that while Indoor Playgroup, in partner with St. John Lutheran Church will provide a safe atmosphere and equipment, there are inherent risks to any child. I understand that as the child’s parent/guardian, I am responsible for any injuries/illnesses my child may encounter while attending Indoor Playgroup. I agree that any staff/volunteer from St. John Lutheran Church or Indoor Playgroup are released from liability of injury or illness. I acknowledge that Covid-19 is a contagious illness and will not hold St. John Lutheran Church or Indoor Playgroup responsible if my child or I catch the virus while attending Indoor Playgroup. I have read and agree to the guidelines of Indoor Playgroup. Please Sign and Date Below.

I have read the above paragraph and agree to the liability guidelines

yes no

INDOOR PLAYGROUP GUIDELINES Welcome to Indoor Playgroup. We have developed this group as a ministry to parents and their children. It is one small way that we can show God’s love to our community. Our Purpose is to provide a safe fun place where parents can socialize and kids can enjoy play time with others. The following contains information and rules for all participants. Location: St. John Lutheran Church (The Purple Door Church) • 1100 N Main St, Celina, OH Times: 1st and 3rd Thursday of the month from 9:30-11 a.m. If questionable weather conditions exist, we will operate under Celina School District. ******If Celina Closes or Delays for BAD weather, we will close!!!!***** Cost: Free - and open to all ages. However, the group is more geared towards toddlers to young elementary aged kids. Contact: Jenelle Gross 419-586-2332, ext. 1004 or j.gross@purpledoorchurch.org 1. Please check-in on the iPads upon arrival. Fill out wavier (yearly). 2. Children must leave personal play items at home. (Exception for non-mobile infants) 3. Please enter through the Family Life Center (FLC) - Door #10. 4. The maximum number of children an adult can bring is 6. 5. You are responsible for the behavior of all children you bring. Children are not allowed to hit, kick or harm others present. You’re responsible to discipline your children when necessary. We understand kids are learning! 6. No throwing toys, climbing on chairs, jumping off of equipment, etc. 7. The stage and band instruments are not a part of indoor playgroup and are off limits. 8. All children attending indoor playgroup must be supervised by an adult at all times. If leaving the gym area for any reason, you must take other children in your care or ask another adult to supervise them in your absence. 9. Please supervise children in the rest room at all times. (Changing station/restrooms are located in the hallway right outside of the gym.) 10. If bringing other children to Indoor Playgroup (not your own), their parents/guardians must have read & signed the guidelines & liability release for their children to participate. 11. We ask that each family volunteers to tear down once a month. (Calendar sign up available at sign-in.) 12. Keep sick children home. No one with a communicable disease (fever, chicken pox, covid-19, pink eye, etc) should not be attending Indoor Playgroup. If a child or parent contracts a contagious disease after having visited Indoor Playgroup, the parent/guardian must inform Jenelle immediately so that families exposed can be notified. (WE NEED TO SIGN IN DAILY FOR THIS REASON!) 13. Report any injuries immediately that occur while at Indoor Playgroup which may require care. Thank you for joining us at the Indoor Playgroup, adhering to the guidelines and making this a positive experience.

I have read the rules and agree to said guidelines above.

yes no

We are asking for help to tear down the toys and equiment one or more Thursdays a month. Please select which Thursday of the month you prefer.

1st 3rd

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Indoor PlayGroup Registration and Liability Release

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