Club Fit | After-School Program Registration

After-School Program Registration

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Contact Information*
Please reference policies should medication need to be available for your child. Health plan must be submitted with physician’s signature.

I authorize the monthly rate will be charged to the card/bank account I have provided on the first of every month, commencing on August 1, 2019 through June 1, 2020. I agree to pay all such charges. Participants will be billed:

General After School Care: Drop off until 5:30 pm – $120 per month, per child
Late pickup for General Care will be billed in ½ increments @ $5 per ½ hour per day
Extended After School Care: Drop off until 7:00 pm – $140 per month, per child
Annual Registration fee due with registration: $50 per family (non-refundable)

In the event of an emergency requiring medical attention, I hereby grant permission to a physician or hospital personnel designated by Club Fit to attend my son/daughter. I expect every effort will be made to contact me in order to receive my specific authorization before any hospitalization.

I hereby represent to Club Fit®, its affiliates, shareholders, partners, officers, agents, servants, employees and representatives (collectively, “Club Fit®”), that I am in good physical condition and am able to safely participate in Club Fit®’s fitness and sports programs. I acknowledge that Club Fit® urges every participant to have a medical check-up before participating in any of Club Fit®’s programs. I appreciate the danger of physical stress, strain, or injury and assume whatever risk is involved as a result of my (my child’s) use of the facilities, equipment or services of Club Fit®.

I hereby release and hold Club Fit® harmless from and against any and all claims, liability, loss, damage, or injury sustained or incurred in connection with my (my child’s) use of the facilities, equipment or services of Club Fit®, and waive any and all claims against Club Fit® for any damage or liability resulting from or in connection with such use, excepting such damage which may be caused by Club Fit®’s negligence.

I/we hereby grant to Club Fit® my/our consent and permission to use my/our/my child’s photographs or other likenesses, entries, pictures, portraits, voices, testimonials, and/or statements made by me/us/my child regarding the Club worldwide and in perpetuity for any and all purposes, including, but not limited to, advertising, trade and/or promotion on behalf of Club Fit®, in any and all forms of media, now known or hereafter devised, including, but not limited to, print, TV, radio, electronic, cable, social media, or World Wide Web, without further limitation, restriction, compensation, notice, review, or approval. I/we hereby release and discharge Club Fit® from any claims and demands arising out of or in connection with such use(s), including but not limited to any and all claims for libel or invasion of privacy/publicity.

I understand and agree to the following School-Age Child Care program policies:

• All children must be in active membership status throughout the school year to participate.

• For busing, parents must call their child’s school and busing company to arrange transportation.

• Our After-School Program runs from the time the bus arrives until 7:00 pm.

• All personal belongings must be clearly labeled with the child’s full name.

• If a child has symptoms of illness or signs of a communicable disease, he/she will be isolated from the other children while the parents are contacted and asked to pick up the child within an hour of notification. If your child has a bathroom accident we will call you. You will be expected to pick up your child or arrange for pickup as soon as possible within one hour.

• If you child requires that medication be available to them during the after school program a health plan must be submitted with a physician’s signature for each medication provided prior to participation. Medications will be kept in the director’s office.

• A designated snack time is available; your child/children can buy from our café or bring a snack from home. No products with nuts allowed. If you would like your child to purchase from the café we will need a house account to be set up under their name.

• A child may be immediately dismissed from the program if the child’s behavior is determined to be detrimental to the child or to the well-being of others in the program. Immediate dismissal of an entire family may occur in the event of inappropriate behavior of parents. Adults are expected to model the desired behavior that is expected of the children. Profanity, threats, or disruptive behavior will not be tolerated. A child who is dismissed due to behavior issues will no longer be eligible to attend the Energy Center at any time.

• No child can be released from the program to any person other than his or her guardian, persons designated in writing by such guardians, or any other persons authorized by law to take custody of a child. Verification of identification will be requested. Guardians picking up must sign each child out by initialing the daily attendance roster.

• Program will be open each day school is in session. If schools are dismissed early we will provide extended care for children enrolled in the After School Program at no additional cost to the parent. Lunch is not served on early dismissal days, so parents must send a lunch or lunch can be purchased at our café. The After-School Program will observe the following holidays: Labor Day, Columbus Day, Veteran’s Day, Thanksgiving, Christmas, New Year’s Day, Martin Luther King Day, Easter, and Memorial Day. We do offer a School’s out Camp during the school breaks and other scheduled days off for an additional fee. For more information please check our website at

This release, waiver and consent shall be binding upon me and my heirs, legal representatives and assigns.

The NYS Board of Health considers the Club Fit Aquatic Center an “off-site pool” requiring parental permission. I hereby grant permission for my child to swim in the Club Fit Briarcliff Aquatic Center during camp hours.