FAMILY PROFILE CARD
Please PRINT Legibly * denotes required information
*Adult #1______
First Name Last Name Relation to Child(ren)
*Adult #2______
First Name Last Name Relation to Child(ren)
*HOME ADDRESS______(street)
______(City) ______(State) ______(ZIP)
*PHONE NUMBER______- ______- ______
EMAIL ADDRESS______
By supplying an email address, you allow us to notify you of any Funtastic open play hours, promotions, new classes.
1. *CHILDS NAME______Male or Female
*DATE of BIRTH______(MONTH) ______(DAY) ______(year)
2. *CHILDS NAME______Male or Female
*DATE of BIRTH______(MONTH) ______(DAY) ______(year)
3. *CHILDS NAME______Male or Female
*DATE of BIRTH______(MONTH) ______(DAY)______(year)
____ Check this line if you have other children listed on the back of this sheet
*How did you hear about us?(Pleasecircle) Friend,Flyer,website,newspaper, myspace, other: ______
RELEASE
THIS RELEASE APPLIES TO THE CURRENT VISIT TO FUNTASTIC PLAY CENTERS AND ALL SUBSEQUENT VISITS – BY SIGNING THIS RELEASE ONE TIME the parent /guardian acknowledges THAT IT’S TERMS AND CONDITIONS WILL APPLY IN EACH SUBSEQUENT VISIT ALTHOUGH NO RELEASE WILL NEED TO BE SIGNED ON THESE SUBSEQUENT VISITS.
Parents / Guardians are totally responsible for their children whilst they are attending Funtastic Play Centers Inc
Funtastic Play Centers provide members of staff who monitor the equipment and the children but parents / guardians recognize that participation in any free-play activities poses a potential risk to their child.
By attending Funtastic Play Centers Inc, the parent / guardian understands that they absolve, release and hold harmless funtastic play centers inc, its officers, directors, managers, employees, shareholders, attorneys & successors from any and all liability for any injuries or damages that their child may sustain in connection with admission and participation in funtastic play centers inc activities.
In case of an emergency the parent will be responsible for taking the appropriate action – in the absence of this action being taken funtastic play centers inc reserve the right to obtain whatever medical treatment is deemed appropriate for the welfare of the child – all of which costs associated with this treatment to be borne by the parent/guardian regardless of whether medical insurance covers such charges and fees.
*SIGNATURE*DATE
______
**Please print the names of any additionalguardian(s) you give permission to monitor your child(ren) while at Funtastic on the back of this sheet. Include theirname(s) and relation to the child(ren). Thank you for helping us keep Funtastic safe.