11 Clearbrook Road Elmsford, NY 10523 (914) 347-5291 www.theplayplace.net
2019 Sports Registration Form
Cancellation, Refund and Make up Policy
$50 deposit due with reservation and balance due before the 1st day of the season. Refunds are at the descreation of the porgram director and General Manager. Program sessions cancelled will be left on account for future use. Make ups requests must be made in advance in writing to Program Director. No refunds will be issued after session begins. We allow 1 make up per session. (must me schedule in advance with directors apporoval)
2019 Sports Waiver of Liability
Indicated in the space below are any health problems or conditions of which The Play Place should be aware (such as heart, back, medical, allergy, muscular, diabetes, epilepsy, chemical or neurological condition, special medication, knee/kidney/shoulder problems, etc.). I understand that risk of injury is inherent in any physical activity and I, on behalf of myself and my child, knowingly and voluntarily accept that risk. I, the undersigned, for myself, my heirs, administrators, and executors, hereby waive and release The Play Place and the staff from all claims or damages of any kind arising out of my child’s participation in the sports program of The Play Place. I further certify that the student is in proper physical condition to participate in the sports program and that he/she has been examined by a licensed physician and found to be in proper physical condition to participate in said program. I, the undersigned, do hereby authorize the Play Place and its designated agents (being teachers or administrators employed by The Play Place) to obtain medical treatment for my said child in emergency situations where I cannot be reached in time to authorize the treating physician to provide such emergency medical services. I understand that I am responsible for any medical expenses and that the absence of health insurance does not make The Play Place responsible for payment of medical expenses. This authority includes the power to authorize all treatment deemed necessary under the circumstances by a licensed physician. This power is in essence a power of attorney and shall remain in effect for one year from the date signed below.
Today's Date: December 10, 2019