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Childcare BRB Program
Exclusively members enrolled in childcare have the option to BRB and leave premesis for 2 hours ($11/hr).
Pre-registration is required by completing the form to reserve your child's spot.
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Child's Name
First
Last
Parent's Name
First
Last
Age of child (children)
Sibling's Name
First
Last
Phone
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Email
Emergency Contact (Name)
First
Last
Emergency Contact Phone #
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Please list the date(s) you would like to pre-reserve your BRB childcare session.
What time will you be dropping off & picking up?
(Includes up to 2 hours)
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Times must be during regular childcare operating hours:
Monday - Thurs: 8am-1pm & 3:30-8pm
Friday: 8am-1pm
Saturday: 8am-12 (noon)
Person(s) authorized for pickup:
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In the event of late pickup, there will be a charge of an additional $15.
Please list any special requests or concerns for staff:
Please list any allergies, health conditions or concerns we should be aware of:
I hereby release and agree to defend, indemnify and hold harmless Spoga, Inc. their owners, employees, agents, insurers, and assigns from any liability or damages of any kind which may arise from the administration of medication to my child as authorized herein. Should my child require medical treatment, I hereby authorize the Camp Directors to consent to medical treatment on behalf of my child, and to notify me as soon as possible thereafter. I hereby release and agree to defend, indemnify and hold harmless Spoga, Inc., their owners, employees, agents, insurers and assigns from any liability or damages of any kind which may arise from consenting to medical treatment as authorized.
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CONSENT FORM AND LIABILITY WAIVER RELEASE
In order for your child to attend Childcare, this consent form and liability waiver must be signed by the child's parent or legal guardian.
A. I hereby give my consent for my child to attend Spoga Childcare. In consideration of the acceptance of the below named minor and on behalf of myself, my child named herein, or our heirs, successors or assigns, I hereby release, waive and agree to defend, indemnify and hold harmless from any claim, loss, liability, damage, expense, or cause of action which may accrue against Spoga, Inc., their owners, employees, agents, insurers or assigns, or any person acting with their permission or authorization arising out of any injury to the minor or loss of damage to any property of such minor during his/her stay at Spoga, in transit to and from Spoga, or during any activity or that may occur from my child’s participation in Spoga’s Childcare.
B. I hereby give permission to Spoga, Inc. to care for my child while I am off premises.
C. I realize and authorize that photographs, videos, written extractions and voice recordings of my child may be taken during various activities for purpose of illustrations, publications, websites, blogs, and other purposes. I hereby authorize and give full consent to Spoga, Inc., to publish and copyright all photographs, videos, written extractions, and voice recordings in which my child appears while he/she is participating in any childcare program. I acknowledge that I will not be informed or reimbursed for any such usage.
D. I hereby give my permission for the Childcare director or a representative authorized and designated by the Spoga director of Spoga’s Childcare to obtain emergency medical/dental care for my child in the event of such necessity. I understand that I will be financially responsible for any such medical/dental service given to my child.
E. I understand and consent that Spoga, Inc., reserves the right to search my child’s belongings and I hereby authorize such searches and I hereby release and agree to defend, indemnify and hold harmless Spoga, Inc., the owners, employees, agents and assigns from any liability or damages of any kind which may arise from any such search.
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Credit Card Authorization Form
Registration due at time of sign up
$22/day per child
*Includes 2 hours of care
Card on file will be charged amount for registration at time of form submission.
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Card Number
Expiration
MM
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YY
CVV
What is this?
3 or 4 digit number printed on the back/front of your credit card
For questions or immediate assistance, please send text to our Membership Team.
985-345-2453
All accounts are managed by Spoga Fitness Center.
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Total
$1.00
