Program Registration | Life Kids After School Programs

Life Kids Guilderland Program Registration

Thank You for choosing Life Kids After School Programs & Camps. Please complete the form below for each child you wish to register with Life Kids. If you have any questions or encounter problems please call: 518-732-5015 Monday- Friday 7am- 6pm.

Select Which Program You Are Registering Your Child For*
- Guilderland (477 Krumkill Rd) Guilderland School Distict
Today's Date*
Child's Name*
First Last
Date of Birth*
School Child Attends*
When Would You Like Your Child to Start Program?*
I would Like a Program Tour*
Which Program(s) are you registering for? ( Please Check All that Apply)*
- After Care
- VIP ( Special Needs Programming)
- Vacation Days
- Camp Weeks
- Drop In Care
Mother's Name*
First Last
Mother's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mother Phone ( Cell or Home)*
Mother Phone ( Work)
Mother's Email*
Enter Email Confirm Email
Father's Name*
First Last
Father's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Father Phone ( Cell or Home)*
Father Phone ( Work)
Father's Email
Enter Email Confirm Email
Emergency Contact*
First Last
Emergency Contact ( Cell or Home)*
Emergency Contact Address*
Street Address Address Line 2 City State ZIP Code
Child Lives with:*
- Both Parents
- Mother
- Father
- Other
Primary Care Doctor*
First Last
Primary Care Doctor Phone
Please Check All that Apply. My Child has*
- Food Allergies or Special Dietary Needs
- Special Emotional or Physical Needs
- Learning Disabilities
- Special Medical Condition ( Please Describe Below)
- No Special Needs or Dietary Restrictions
Please Describe any special needs here. We will contact you if we need further information.
Authorized Pick Up Name*
Authorized Person Telephone Number*
Authorized Person Address*
Street Address Address Line 2 City State ZIP Code
Authorized Pick Up Name*
Authorized Person Telephone Number*
Authorized Person Address*
Street Address Address Line 2 City State ZIP Code
Agreements & Consent for Treatment in Emergencies*
- Emergency Treatments & Documentation
I consent to the enrollment of the child listed above in this facility and have been advised of the policies regarding administration of medications, fees, transportation and the services provided by the facility, and the Office of Children and Family Services regulations under which it operates. I give consent for my child to take part in neighborhood trips (i.e. library, park and playground) away from the facility under proper supervision. In case of accident or injury, I authorize any and all emergency medical, dental, and /or surgical care and hospitalization advised by the physicians, surgeon or hospital (listed on this form necessary for the proper health and well-being of my child. I have provided information on my child’s special needs (Allergies, Diet, Disabilities, and /or Medical Information) to the provider, as may be necessary to assist the facility in properly caring for my child in case of an emergency. I agree to review and update this information whenever a change occurs and at least once every calendar year.
I consent to the LKASP Transportation Policy*
- Transportation Permission
I have been informed that the vehicles used to transport children in the care of Colonie Life Kids is insured, registered, and inspected by the State of New York. I further have been made aware that, while in this vehicle, my child will be properly secured in a safety seat that is appropriate for his or her age in accordance with the requirements of the Vehicle and Traffic Law and that no person under the age of 25 will ever transport my child in said vehicles. Therefore, I give Colonie Life Kids permission to transport my child to and from their facility located at 31 Vly Rd, Albany, NY 12205.
Application of Sun Screen & Bug Spray Permission*
- Sun Screen & Bug Spray Permission
- I Understand that I will provide my own Sunscreen & Bug Spray
I understand that when playing outside during the sunny weather that sunscreen may be necessary. I give the staff at Life Kids Childcare permission to apply any of the following brands of sunscreen to my child every 80 minutes: No-Ad SPF 30, Coppertone SPF 30, Water Babies SPF 30, Banana Boat Kids SPF 30, Equate SPF 30. If my child has an allergy to any of these I will provide an alternative non-aerosol sunscreen for my child. I also give the staff at Life Kids Childcare permission to apply any of the following non-aerosol bug sprays to my child: OFF! Skintastic Family (4.75% DEET) OFF! Family Care Insect Repellents (5,7, or 15% DEET), Cutter All Family Mosquito Insect Repellent (7% DEET). If my child has an allergy of these I will provide an alternative non-aerosol bug spray for my child.
Photography Release*
- I Consent to the LKASP Photography Release
- I do not consent for photo release
I give Life Kids Childcare permission to photograph my child my regular daily group activities and to display and publish such photographs in printed materials and/or on the website, colonielifekids.com.
Movie Release*
- My child has my permission to view G and PG rated movies while at Life Kids Childcare.
- I prefer my child to not watch any movies and or TV while at program or camp
I consent to the LKASP Playground Release of Liability*
- Playground Release of Liability
In consideration of my child participating in play on the Life Kids Playground I attest that I understand the nature of this activity and that my child is qualified, in good health, and in proper physical condition to participate in such activity. I acknowledge that if I believe event conditions are unsafe, I will immediately request that my child discontinue participation such activity. I fully understand that this activity involves risks of serious bodily injury, including permanent disability, paralysis, and death, which may be caused by my child’s own actions, or inactions, those of others participating in the event, the conditions in which this event takes place, or the negligence of the “releases” named below; and that there may be other risks either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for loses, cost, and damages my child incurs as a result of participation in the activity. I hereby release, discharge, and covenant not to sue Life Kids, its respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the activity takes place, (each considered one of the “RELEASES” herein) from all liability, claims demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the “releases” or otherwise, including negligent rescue operations and future agree that if, despite this release, waiver of liability, and assumption of risk I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify, save, and hold harmless each of the Releases from any loss, liability, damage, or cost which any may incur as the result of such claim. I have read this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, and I understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force effect.
ELECTRONIC SIGNATURE*
- By checking this box I am signing that all the information provided is correct to the best of my knowledge.
Comments
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