Policy Acknowledgement. All employees must acknowledge in writing, through the drug policy acknowledgement form, that is included in this agreement, that they have been informed of the above policy and agree to abide by it in all respects.
Policy Acknowledgement. I read and agree to abide by the payment agreement and understand the payment policy, registration fee, and NSF fee policy. Parent/Guardian Signature Date Child(ren)’s Name Email Primary Phone Secondary Phone SUMMER CAMP CONNECTION AUTO PAYMENT AUTHORIZATION Complete this section to authorize automatic monthly payments to the Park District by credit card or bank account (EFT) Credit Card (for Auto Charge) Credit Card Number Expires CVV Cardholder Name Signature Date Checking Account (for EFT) Attach voided check to complete EFT authorization. Name on Account Signature Date
Policy Acknowledgement. I agree to abide by all policies listed in The Fitness Center’s Membership Policy Agreement, Orientation, all posted signs, and any addendums in their entirety. Signature: Date: Witness (staff member): Waiver of RELEASE AND ASSUMPTION OF RISK AGREEMENT I, , of , having been born on , acknowledge, declare and agree to all Policies and Best Practices contained within this document.
Policy Acknowledgement. Policy Statement: Cambridge Early Learning Centre has a number of policies that set out the procedures that are in place for the care and education of the children who attend. We strongly urge you to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service, and understand how you can have input to policy review. Below are policies that require acknowledgement on enrolment by signing at the base of this section please. I will not bring my child to the Centre in the event of sickness, fever or any infectious illness, e.g. chicken pox or conjunctivitis. Diarrhoea and/or vomiting must have ceased for at least 48 hours before children return to the centre. I will not bring my child to the Centre until 24 hours after antibiotic treatment has commenced, if these have been prescribed. I have had the Centre procedure for administering medicines explained. I have had explained to me the Centre policy on the monitoring of sleeping children and agree with the procedure (this can be found displayed on all sleep room doors in the centre). I acknowledge that if my child has special dietary requirements I will provide the Centre with substitute food items. I agree to give 10 days (2 weeks) notice before withdrawing my child from the Centre. I agree to pay 2% interest per month on fees overdue one month or more and agree to pay any costs incurred by the Centre in the recovery of my overdue fees. SIGNED: Parent Declaration I declare that all the above information is true and correct to the best of my knowledge. Parent/Guardian Signature: __________________________ Date: ____ /____ / ____ Service Declaration On behalf of Cambridge Early Learning Centre, I declare that this form has been checked and all relevant sections have been completed. Service Provider Signature: ____________________________ Date: ____ /____ / ____ Civil Defence Emergency Information: The Centre has an emergency plan for evacuation should a civil defence emergency occur. An important part of the plan is the policy of not releasing children after an emergency to anyone other than those persons nominated by the parents. It is also important that we have emergency contact, medical, dietary and other information on hand in our emergency kit (as distinct from the enrolment information kept elsewhere in the building.) Please complete the information below Child’s Name_________________________________________________________ Parent/s Name_______...
Policy Acknowledgement. Board acknowledges that it has received copies of Rural/Metro’s Code of Ethics and Business Conduct and Rural/Metro’s Anti-Kickback Policy.
Policy Acknowledgement. I agree to abide by the Waterloo Regional Trailhead - Facility Use Rules & Procedures. Signature: Date: Warming Room & Back Patio Rental Agreement Facility Use Rules & Procedures It is the goal of the city to have the Waterloo Regional Trailhead utilized to the greatest extent possible by all members of the community. The facility will be rented out on a first-come, first-serve basis and the instructions for proper rental are below.
Policy Acknowledgement. I acknowledge that I have read, understood and agree to all of the items contained in this document. I also acknowledge and accept full and complete responsibility for prompt payment for all services rendered by Golden Sky Counseling, as well as for late cancellations and no shows prior to the next scheduled appointment. Client Name Client (or Guardian if client is a minor) Signature Date
Policy Acknowledgement. Washington Regional Medical System (WRMS) and its affiliated entities will comply with federal and state laws governing the privacy of patient health information. The Health Insurance Portability and Accountability Act of 1996, 42 U.S.C.§1320d et seq. (HIPAA), and the implementing regulations thereto found at 45 C.F.R. Parts 160 and 164 set forth the regulations for protecting the privacy of patient health information.
Policy Acknowledgement. The undersigned has read and do understand fully the policies both of the Timberlane Regional Performing Arts Center and of the Timberlane Regional School District. Furthermore, I agree on behalf of my organization to abide by these policies and to take full responsibility, financial, and otherwise, for the behavior of my organization and its audience during the entire length of time that we use the Performing Arts Center. Signed: , of_
Policy Acknowledgement. Releases I give my permission to this center to apply □ sunscreen and □ insect repellant to my child. Please check which product you will permit. Initial I understand that I must supply my own sunscreen and/or insect repellant with a valid expiration date, and it will be labeled with my child’s name. I have special instructions for the application process. □ None □ I understand that Little Frogs & Polliwogs Learning Center reduces the staff to child ratios during naptime hours in accordance with New Hampshire Code of Administrative Rule He-C 4002.33 through He-C 4002.36 I/we have read and follow the guidelines set out in the LF&P ‘Family Handbook’, that can be found online at: xxx.xxxxxxxxxxxxxxxxxxxxxxx.xxx My child may participate in activities involving all cultures/religions In the event of an emergency it is the policy of LF&P that no guarantee is implied by a perfect incident management system. As personnel and resources may be overwhelmed, LF&P can only endeavor to make every effort to manage the situation with the resources and information available at the time. In the event of an off-site evacuation children will be transported, by any means necessary, to another location. I/we understand that I should not contact the center, but will be notified of the location ASAP. I will provide a small blanket and crib sheet for nap, formula, baby food, a ready to serve lunch, diapers and wipes (if needed), a bathing suit and towel in the summer and proper winter clothing in the winter. Caviar Only I/we give permission for my child, on occasion be walked, in a stroller, to Pine Island Park with his/her teacher. I understand that during this time my child will remain in the stroller. Kindergarten & School Age Only On occasion my child may walk with his/her class and teacher to Pine Island Park. Tadpoles 1 & 2, Nursery, Preschool & Kindergarten Only My child may participate in the ‘Tumbleweeds Program’. Nursery, Preschool, Kindergarten & School Age Only With prior approval, my child will be allowed to participate in class field trips. Parent Signature Date: Staff Initials Rate Agreement and Contract Xxxxx’s name Birth date Hours of Operation Regular operating hours are Monday through Friday from 6:30 AM to 5:30 PM except closings for various holidays, and inclement weather as described in the Family Handbook. Please consult the current calendar for holidays. There is no reduction in tuition as a result of center closures. Scheduled Attendance The days and hours...
