Event Registration

Parent Name*

First Last

Phone-Best number to be reached day of event*

Please list any adults permitted to sign your child/ren in or out of the Child Care Program or Babysitting.

Anyone who is not on this list will not be allowed to sign your child out.

Phone-Emergency Contact (different than above number)

Email*

Child 1 First and Last Name*

Child 1 Age and school grade if applicable*

Child 1 allergy related Info or specific notes

Child 2 First and Last Name

Child 2 Age and school grade if applicable

Child 2 allergy related Info or specific notes

Child 3 First and Last Name

Child 3 Age and school grade if applicable

Child 3 Allergy Related Info or Specific Notes

Child 4 First and Last Name

Child 4 Age and school grade if applicable

Child 4 allergy related Info or specific notes

Child 5 First and Last Name

Child 5 Age and school grade if applicable

Child 5 allergy related Info or specific notes

Child 6 First and Last Name

Child 6 Age and school grade if applicable

Child 6 allergy related Info or specific notess

Days of Babysitting Services Required-You can select more than one option

For infants and children preschool age and under. For older children programs see below.

Days of Kids Kahal services required-You can select more than one option

TK-6th grade only-Family Service geared toward Elementary School age children, however, chidden ages 2-6 can attend without an accompanying adult. All younger children MUST be accompanied by a parent. Please note that use of electronic devices is strongly prohibited during High Holy Day Programming. Electronic devices will be confiscated and returned at the end of service.

Consent*

I agree to the below Disclaimer and Waiver.

DISCLAIMER/WAIVER/HOLD HARMLESS/LIMITATION OF LIABILITY

We appreciate your cooperation knowing that both Volunteers and Child Care Staff reserve the right to return your child/ren to their parents for any behavior deemed unsafe to themselves or others.

To the maximum extent permitted by law, Crunch Care assumes no liability or responsibility for, and makes no representations or warranties about, any information, material, errors, omissions, services, candidates, applicants, referrals, employees or potential employees (including but not limited to the qualifications or performance of individuals) it provides to Client. Client understands and agrees that Client’s use of Crunch Care’s services is at Client’s own risk. Except as specified in this Agreement, Crunch Care does not provide and specifically disclaims any express or implied guarantees or warranties to Client.

By signing this document, Client hereby waives and releases Crunch Care and its owners, agents, employees, officers, directors, attorneys, representatives and affiliated entities from all liability, including but not limited to liability arising from negligence, equipment, or the actions of any third party, arising under law or otherwise.

This Agreement does not govern claims that cannot be released by private agreement or that cannot lawfully be waived. In addition, this Agreement does not limit either party’s right, where applicable, to file, cooperate with or participate in an investigative proceeding of any governmental entity, or to file charges that do not seek personal relief for released claims with any governmental entity.

Additionally, Client shall indemnify, defend and hold Crunch Care and its owners, agents, employees, officers, directors, representatives, attorneys and affiliated entities harmless against any damages or liability whatsoever arising out of or in any way in connection with the placement, employment or association of an employee or other person referred to Client by Crunch Care, regardless of how, when, or where any damages or liability was incurred.

During the term of this agreement and for one year thereafter, Client agrees not to solicit, entice, encourage or induce any temporary employee or Assigned Employee of Crunch Care or any of its subsidiaries, or who is associated with or under contract with Crunch Care, with whom Client worked, to become employed by or associated with any person, firm or corporation other then Crunch Care. Client agrees not to approach any such person described above for such purpose or authorize or knowingly approve the taking of such actions by any other person, firm or corporation or assist any such person, firm or corporation in taking such action.

Finally, in no event shall either party to this Agreement be liable for consequential, incidental, exemplary, punitive, special or indirect damages of any kind. Further, a party’s aggregate liability for damages of any kind under this Agreement shall be limited to the amount of the fees received by or owed to Crunch Care from Client. If any waiver, exclusion or limitation of damages is not permitted by law, the parties’ liability to each other is limited to the maximum extent permitted by law.

The parties to this Agreement hereby certify, represent and warrant that they have carefully read this Agreement, that they fully understand its final and binding effect, and that they agree to all of its terms and conditions.

I have been told that TrustLine® is California's registry of in-home child care providers, tutors and in-home counselors who have passed a background screening. It was created by the California Legislature in 1987 and is a powerful resource for parents hiring a nanny or baby-sitter. All caregivers listed with TrustLine® have been cleared through a fingerprint check of records at the California Department of Justice. This means they have no disqualifying criminal convictions or substantiated child abuse reports in California. TrustLine® is administered by the California Department of Social Services and the non-profit Child Care Resource and Referral Network. It is endorsed by the California Academy of Pediatrics. For more information visit www.trustline.org. An employment agency is prohibited by law from placing a child care provider unless the provider is a Trustline® applicant or a registered child care provider. Parents can check if a provider is registered on TrustLine® by calling 1-800-822-8490. You'll need to provide (1) the person's full name and (2) driver's license number.

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