Fill out the following electronic form once for each child you will bring to the playroom. You will still need to bring a doctor’s note if your child has pre-existing medical conditions. You can also download the form for printing (click here) and bring it in with you.

Required fields marked with *


RAC PLAYROOM REGISTRATION FORM

Choose preferred club: *

 

Child's full name: *

Your name: *

Your telephone #: *

Child's home address: *

Child's age: *

Relation to child: *

Child's telephone #

Child's date of birth: *

 


IN CASE OF EMERGENCY NOTIFY:

 

Father's name

Father's address

Father's phone #

Mother's name

Mother's address

Mother's phone #

 
 

Grandparent's (or other) name

Grandparent's (or other) address

Grandparent's (or other) phone #

 

Is your child allergic to anything? *

If yes, specify

Please indicate any allergic reactions to medications, foods, or environmental conditions:

Does your child have any special needs you are aware of? *

If yes, what are the physicians recommendations?

Does your child take any medications? *

If yes, please specify:

Are there any other restrictions placed on your child's activity, diet, or any other aspect of their playroom participation? *

If yes, please specify:

 
 

POLICY STATEMENT REGARDING FIRST AID OR OTHER MEDICAL TREATMENT

RAC Playroom Staff are only trained in CPR and AED use. They are not first aid certified or able to provide any other medical care. Children with pre-existing medical conditions must be accompanied by a doctor’s note before they can use the playroom. The RAC reserves the right to refuse playroom admission to any child without proper medical clearance.

Playroom Staff are directed not to provide children with medical care such as:

      1. Epi-Pen or injections of any kind
      2. Checking blood sugar
      3. Administering inhalers

Name of child's pediatrician: *

Pediatrician's address: *

Pediatrician's phone: *

Please list anyone that is prohibited from picking up your child from the playroom:

I ALSO AGREE THAT AS PART OF THE ENROLLMENT, I MUST SHOW DOCUMENTED PROOF (BIRTH CERTIFICATE) THAT I AM THE LEGAL PARENT OR GUARDIAN OF THIS CHILD(REN).

I AGREE THAT IN CASE OF ACCIDENT OR INJURY, EMERGENCY MEDICAL CARE MAY BE GIVEN IN THE EVENT I, OR PERSON’S DESIGNATED AS EMERGENCY CONTACTS IN THIS PACKET, CANNOT BE REACHED.

I UNDERSTAND I AM RESPONSIBLE FOR MY CHILDREN BEFORE THEY ENTER AND AFTER THEY LEAVE THE PLAYROOM. I FURTHER UNDERSTAND CHILDREN ARE NOT PERMITTED IN ANY OF THE EXERCISE AREAS OR LOCKER ROOMS.

I CONSENT TO THE REGISTRATION AND ENROLLMENT AT THIS PLAYROOM OF THE CHILD SPECIFIED IN THIS PLAYROOM PACKET. I HAVE BEEN ADVISED OF THE POLICIES REGARDING FEES, HOURS, AND OTHER RULES, REGULATIONS, AND SERVICES PROVIDED BY THIS FACILITY. I UNDERSTAND ALL PLAYROOM FEES ARE NON-REFUNDABLE.

I HAVE READ THE ABOVE AND UNDERSTAND THE RAC POLICIES.

Electronic signature of parent/guardian (full name) *

Date signed *

Continue reading rules below, then press the "SEND" button on the very bottom of the page

PLAYROOM FEES

Children can only stay in the playroom
for a maximum of 2 hours per visit

$1.50/child per ½ hour or less
$2.00/child per hour
$2.75/child per 1 ½ hours
$3.50/child per 2 hours

Infants can only stay in the playroom
for a maximum of 1 ½ hrs per visit

$2.50/infant per ½ hour or less
$3.25/infant per hour
$4.25/infant per 1 ½ hours

Children are defined as those 12 months (if walking) to 12 years of age

Infants are defined as those 4 months up to 12 months of age

Children over 12 and infants under 4 months of age are not permitted in the playroom

Pre-pay Funds or Day Passes must be purchased at the front desk in various incremental amounts in advance of scheduling an appointment.


APPOINTMENT SCHEDULING AND CANCELLATION POLICIES

1. Parents must purchase Pre-Pay Funds on account or day pass from the front desk and have all registration paperwork on file before their child is permitted to use the playroom.
Use of the playroom is limited to children of members only.

2. THE PLAYROOM IS STAFFED BASED ON APPOINTMENTS MADE AT LEAST 24 HOURS IN ADVANCE
3. RESERVATIONS MADE WITH LESS THAN 24 HOURS OR WALK-INS MAY NOT BE ABLE TO BE ACCOMMODATED
4. ALL NO SHOWS OR CANCELLATIONS MADE WITH LESS THAN 24 HOURS NOTICE WILL BE CHARGED THE AMOUNT OF TIME FOR WHICH THEY MADE A RESERVATION
5. THE PLAYROOM CAN ONLY ACCEPT RESERVATIONS MADE IN PERSON OR BY PHONE DURING SCHEDULED PLAYROOM HOURS
6. Only playroom staff can accept reservations for the playroom. Attempts to make a reservation through the front desk or other employees will not be accepted
7. Cancellations made at least 24 hours in advance may be left on the playroom voice mail; however reservations left on the voice mail will not be accepted
8. The playroom may not be open during the posted hours if there are no children or infants scheduled during those hours. If parents attempt to make a reservation during posted playroom hours, but cannot reach a staff person to do so, they can leave a message on the voice mail, and the Playroom Manager will contact them


CHILD DROP OFF/PICK UP POLICIES


1. Parents must sign their children in before entering, and sign their children out before exiting the playroom
2. Only the parent, and not the staff or any person, is allowed to sign their children in and out
3. Parents should label their children’s belongings brought into the playroom
4. SICK CHILDREN ARE NOT ALLOWED IN THE PLAYROOM. If your child has a fever, constant cough or runny nose, you will be called to pick up your child. Please notify staff immediately if your child develops a communicable illness, so we can notify other parents
5. PLEASE MAKE SURE TO HOLD YOUR CHILD’S HAND AT ALL TIMES WHEN IN THE CLUB
6. Parents are not permitted to leave the club while their children are in the playroom
7. Parents or children may not enter the playroom without a staff member being present. This includes children of staff.


PLAYROOM FOOD POLICIES

The following are the only foods/drinks permitted in the playroom: Goldfish crackers, Dry cereal, Pretzels, Graham crackers, Butter cookies, Drinks in spill-proof cups (no drink boxes),Nuts are not permitted in the playroom under any circumstances

*Parents that wish to give their child access to food while in the playroom should bring their own, and each article must be labeled with their child’s name; the playroom is not required to provide snacks for the children.

PARENTS MUST CLEARLY NOTE ANY FOOD ALLERGIES THEIR CHILD HAS IN THE APPROPRIATE LOCATION OF THE PLAYROOM REGISTRATION PACKET


CHILD BEHAVIOR POLICIES

The safety of the children is of utmost importance. Aggressive or inappropriate behavior will not be tolerated. This includes, but is not limited to: Biting, Hitting, Kicking, Swearing, Pushing to the ground

*Playroom staff that witnesses aggressive or inappropriate behavior will issue a written warning detailing the incident, which the parent must sign

*A second incident of aggressive behavior will result in the child’s playroom privileges at all clubs being revoked for a period of 2 months

 

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