Child Care Registration Request Form

Please fill out the following information to register your child for child care. You will receive an email notification once registration has been completed.

PLEASE ALLOW 48 HOURS FOR REGISTRATION TO BE COMPLETE.

Once you have received an email notification regarding the completion of your registration, you can reserve yourself and your child any time up until ONE hour before the start of the class. Be sure to reserve yourself for the workout time that you will be attending and also reserve yourself for the child care appointment that you need.

Do not assume that other kids are reserved for child care. If no children are reserved for the scheduled child care appointment, our child care providers will not show up.

***COMPLETION OF THIS FORM IS REQUIRED BEFORE YOU BRING YOUR KIDS TO THE CHILD CARE ROOM. WAIT FOR THE EMAIL NOTIFICATION TO ENSURE REGISTRATION IS COMPLETE***

Please complete the form below

Parent Name

First Name

Last Name

Parent Email

Child No 1.

First Name

Last Name

Child No. 2

First Name

Last Name

Child No. 3

First Name

Last Name

Child No. 4

First Name

Last Name

Does your child or any of your children have any medical conditions, allergies, or special needs that we need to know?

Please list which child and his/her medical conditions/allergies/special needs.

The following people are allowed to pick up my child(ren) from CrossFit Edwardsville:

Please list full names and phone numbers of people allowed to pick up your child.

WAIVER OF LIABILITY, RELEASE, ASSUMPTION OF RISK & INDEMNITY AGREEMENT

I understand that by checking this box for the Childcare Rules and Childcare Waiver of Liability, I release and hold harmless Skelly Health & Fitness, LLC DBA CrossFit Edwardsville, and its owners, directors, staff, contractors, officers, advisors, employees, agents, instructors, volunteers, childcare workers, and all other persons or entities acting for them from any and all claims, demands, suits, cost and charges, in connection with or arising out of CrossFit Edwardsville childcare service, including but not limited to, personal injury, bodily harm, injury, or property damage occurring while the above child/children is/are in their care at CrossFit Edwardsville. I have read and understand the CrossFit Edwardsville’s Childcare Rules and Policy.

CONFIRMATION

Please check the box indicating that you understand you must remove your reservation from the scheduled appointment or a $10 no-show fee will be assessed. You have until one hour before the class starts to remove your reservation.

I understand that a $10 no-show fee will be assessed if I am reserved for a child care appointment and I do not show up with my child.

PERSONAL LIABILITY

Please check the box indicating that you understand you will be held liable if your child causes any damage to any property at CrossFit Edwardsville.

I understand that I will be held liable if my child causes any damage to any property at CrossFit Edwardsville.

Signature Box

By typing my full legal name below and submitting this form online. I certify that I have read and understand all of the terms of the gym agreement and agree to continue to abide by all of the terms of this agreement. I have answered all of the questions to the best of my ability and am indicating that I am of sound mind. (If under 18, Parent or Legal Guardian signature and completion of Parental Consent For Minor Membership form is required). Your e-signature is considered legally binding. This electronic document can be made available by request by emailing Membership@CrossFitEdwardsville.com.