Champion Kidz Educational Institute and Childcare

1711 N. Post Road, Indianapolis, IN 4619

(317) 755-2822

Childcare Assumption of Risk, Permission & Liability Release

Please read and sign the following statement:

I, the legal guardian, and/or parent of

declare that I have read and understand

Champion Kidz Admission Policies and Procedures ascontained in this document as well as

in the Parent Handbook.

Date: Signature:

For Office Use Only

Parent orientation/interviewed on:

Preferred start date:

Wait list: Yes No

Enrollment forms received: Yes No

Application/Deposit for beginning services received: Yes No

$50.00 for 1 child $85.00 for 2 children $130.00 for 3 children

Deposit for holding enrollment received: Yes No

Office Signature:

Date:

Liability Release Form

I agree this Waiver and Release of Liability shall apply to each day my child(ren) is in attendance at

Champion Kidz Childcare LLC regardless of the date this form is signed below.

I agree I will assume the risk and full responsibility for any and all injuries, losses, or damages, which

might occur to my child(ren) or other members while on the premises of the childcare or participating in

any off-site activity involving traveling to a location,; and to the maximum extent of the law. I agree to

waive and release any and all accidents, claims, suits or related causes of action against Champion Kidz

Childcare LLC, their owners, employees or agents for injury, loss, death, costs or other damages to me,

my heirs or assigns, or third parties for claims, suits, or related causes of action asserted against the

childcare arising or resulting from my child(ren) conduct while participating in the childcare & programs

or activities. I hold harmless Champion Kidz for incidents/situations of neglect, misconduct from another

child or adult that was outside of the business control or knowledge.

*This is does not release Champion Kidz Childcare from the responsibility of liability if something is done

to be intentionally negligent to harm my child(ren) by Champion Kidz Childcare LLC.*

Date: Parent/Guardian Signature:

Assumption of Risk: Participation in physical activities can involve motion, rotation, and height in a unique environment and as

such carries with it a certain assumption of risk. The undersigned and the participant(s) choose to

voluntarily enter upon said premises under the control of said limited liability company, knowing their

present condition and knowing that said condition might become more hazardous and dangerous during the

time the participant or the undersigned is upon said premises. The undersigned and the participant(s)

voluntarily assume any and all risks of loss, damage, or injury that may be sustained by the participant(s)

and/or the undersigned or any property owner by them while on or upon said premises above. Champion

Kidz Childcare LLC may, but shall not be obligated to carry insurance on the participant(s) and the existence

insurance shall not change, alter, or increase the liability of the LLC to the participant(s) and the undersigned

or affect the terms of this Release. In signing the Release, the undersigned acknowledges:

a) That they have read thoroughly, understands completely the terms of Registration and Release,and signs it

voluntarily.

b) That the undersigned signing either for themselves, or as Legal Guardian is, in fact, the true and legal

guardian of the participant(s).

Date: Parent/Guardian Signature:

Medical Release: / A copy of the following section will be carried with a Champion Kidz Childcare LLC staff member when transporting your child. / The undersigned gives permission for Champion Kidz Childcare LLC owners, employees, to

and/or agents seekemergency medical treatment for the participant(s) in the event they are unable to reach any parentor

guardian. The undersigned also agrees that they themselves will be responsible for any financialdebt incurred

by said action.

Date: Parent/Guardian Signature: