Emergency Contact Form

EMERGENCY CONTACT DETAILS:

arrow&v

HEALTH INFORMATION:

We must have permission for anyone other than parent/guardian to pick child up from class.

Parent/Legal Guardian Consent and Agreement for Emergencies As parent/legal guardian, I give consent to have my child receive first aid by facility staff, and, if necessary, be transported to receive emergency care. I understand that I will be responsible for all charges not covered by insurance. I agree to review and update this information whenever a change occurs.

*If registering multiple children, click submit and then fill out a new emergency contact form.

Thanks for submitting!
We’ll contact this person only in case of emergency.

Activity Participation Waiver

Waiver: In consideration of being permitted to participate in any way with Beyond the Toolbox LLC, I, for myself, my child(ren), personal representative or assigns, do hereby release, waive, discharge, and covenant not to sue Beyond the Toolbox LLC, its officers, employees, and agents from liability from any and all claims including the

negligence of Beyond the Toolbox LLC, resulting in personal injury, accidents, or illnesses (including death) and property loss arising from, but not limited to, participation in Beyond the Toolbox LLC classes.

Assumption of Risks: Participation in Beyond the Toolbox LLC classes carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions 3) catastrophic injuries including paralysis and death.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in Beyond the Toolbox LLC classes. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

Covid-19 Assumption of risks: The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illnesses and even death.

I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize Beyond the Toolbox LLC services and enter Beyond the Toolbox LLC premises.

GUIDELINES: To responsibly protect students, families, and teachers with Beyond the Toolbox LLC here are some guidelines that the Beyond the Toolbox LLC staff will adhere to, and we ask families to adhere to:

Staff Responsibilities

Staff will wear masks at drop off, during class, and at pick up. Children will be sent home without exception if they exhibit any of the following: persistent cough, fatigue, or fever. Class size will be limited to 15 or fewer children at all times. Hand washing will be increased and happen before all activities involving shared materials.

 

Parent Responsibilities

Families will be asked to report if anyone in their household has had a fever in the last 24 hours and to keep their child home, if so. Fever policy is always in place for children actively in our care, but will extend to family members for the foreseeable future. Parents are asked to socially distance during drop off and pick up.

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD Beyond the Toolbox LLC HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in Beyond the Toolbox LLC classes and to reimburse them for any such expenses incurred.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

Thanks for submitting!

Media Release

Beyond the Toolbox LLC requests your permission to reproduce through printed, audio, visual, or electronic means activities in which your child(ren) has participated. Your authorization will enable us to use specially prepared materials to increase public awareness and promote continuation and improvement of education programs through the use of mass media, displays, brochures, websites, etc.

a. I, as a parent or guardian, of the above named student fully authorize and grant Beyond the Toolbox LLC and its authorized representatives, the right to print, photograph, record, and edit as desired, the biographical information, name, image, likeness, and/or voice of the above named student on audio, video, film, slide, or any other electronic and printed formats, currently developed, (known as “Recordings”), for the purposes stated or related to the above.

b. I understand and agree that use of such Recordings will be without any compensation to the student or the student’s parent or guardian.

c. I understand and agree that Beyond the Toolbox LLC and/or its authorized representatives shall have the exclusive right, title, and interest, including copyright, in the Recordings.

d. I understand and agree that Beyond the Toolbox LLC and/or its authorized representatives shall have the unlimited right to use the Recordings for any purposes stated or related to the above.

e. I hereby release and hold harmless Beyond the Toolbox LLC and its authorized representatives from any and all actions, claims, damages, costs, or expenses, including attorney’s fees, brought by the student and/or parent or guardian which relate to or arise out of any use of these Recordings as specified above.

I have read and understand the release, and I agree to accept its provisions.

Thanks for submitting!