Club Fit | After-School Program Registration BR

After-School Program Registration BR

Program Option*

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

I understand there is a one-time annual registration fee per family of $50 program billed at time of registration. I also understand that my total Program fee per child will be billed in the monthly installments indicated above on the first of every month, commencing on August 1, 2019 through June 1, 2020. I authorize the annual registration fee and monthly Program installments to be charged to the card/bank account I have provided. I agree to pay all such charges. I know I must request a termination three (3) business days before the end of any month to avoid the next month’s Program charges. Partial months are not refunded.


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/my child is in good physical condition and is able to safely participate in Club Fit’s fitness and sports programs. I/my child acknowledge that Club Fit urges every participant to have a medical check-up before participating in any of Club Fit’s programs. I/my child 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.
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.

I understand and agree to the following After School Program policies:

• All children must be in active membership status throughout the school year to attend. If you freeze your child’s membership, you will forfeit your child’s spot in the After-School Program and you will not be charged the remaining monthly installments, in accordance with our notice provisions. You may, however, hold your child’s spot during the membership freeze (but your child may not attend the Program) if you elect to continue to pay the Program’s monthly installments during the membership freeze.

• 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 ask to pick up your child as soon as possible but no later than within one hour. If your child has a bathroom accident we will call you.

• 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. I warrant that I have notified the Program of all my child’s allergies. I also understand that I have a continuing obligation to notify the Club of allergies in the event new allergies are discovered druing my child’s participation in the Program.

• 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 Program 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 may 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

• Required Timing of Termination Notice: You must provide written notice of such resignation to the Program. Written notice may be provided via fax, email, letter, or by stopping by our Club Experience Department and filling out a form. If such notice is received at least three (3) business days prior to the end of the month, the program participant will be terminated as of the last day of that month. If such notice is not received at least three (3) business days prior to the end of the month, the program participant will be terminated as of the end of the following month. Program registrations that are reactivated during the same school year will be required to pay and additional registration fee upon rejoining the prgram. Withdrawl from the program does not terminate your child’s Membership Agreement with the Club.

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

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