WP E-Signature by Approve Me - Sign Documents Using WordPress -

{{gravity-field-id-62}}-Olathe Admission

1 of 2 Forms to Sign
(All forms must be signed at the bottom to complete registration)

On behalf of myself, my spouse, and each child designated (children) I, , enter into this Admission Form Agreement ("Agreement") with Swan Corporation, a Kansas Corporation, dba KidsPark, regarding the provision of a supervised, indoor play environment for my Child(ren)

In this Agreement, "KidsPark" refers to KidsPark Inc., the franchisor, and all of its franchisees as "KidsPark" since all centers offer visit reciprocity so you can attend any center as long as your registration is active (you have visited at least one time during each 12 month period starting from your original enrollment date).

1. Facility Use: Subject to this Agreement and other terms as drop-in, short-term child care for my Child on a flexible time basis, which includes use of facilities and participation in art and play activities. Our center does not take field trips, provide transportation or employ Community Resource Services.
2. Future Visits: This Agreement, the Registration Form and the Release will be kept on file at the KidsPark center where you originally registered. It will continue to constitute binding obligations for any future visits my Child(ren) may make to KidsPark or any location of Franchisor or other franchisees. However, this Agreement does not obligate KidsPark to continue to provide services, and KidsPark reserves the right to terminate services and to refuse admission to any child for any reason without liability whenever the needs of the child cannot be met, the child poses a direct threat to the health and safety of others, fundamental alteration to the program is needed, or the child alters the centers' teacher to child ratio.
3. Payment: Payment for KidsPark services will be due at the time of each check-out in cash or by credit card charge in the amount calculated by multiplying the time elapsed from check-in to check-out by the rates posted at the time of the visit, and for posted amounts for other services; such as, family registration fee, meals and retail items. KidsPark may charge a service fee for any unpaid invoices or late pick-ups. No refunds are given. Any changes in fees will be posted for at least 30 days.
4. Health Policies:
  a) Health: My Child(ren) is in excellent health and physical condition and has no medical, psychological, physical, or mental condition that has not been disclosed to KidsPark on the attached Registration Form. My Child(ren) does not have any infectious, contagious, or communicable diseases. My Child does not have any infectious, contagious, or communicable diseases. I understand that I am required to provide a completed signed copy of KDHE Medical Record and Child Health Assessment form to KidsPark as part of this registration and admission agreement if my child, under the age of 6 years, visits 10 or more times in a 30-day period. I further understand that I may transfer this form to KidsPark from another regulated childcare facility in Kansas. I also understand that it is acceptable for me to submit a School Health Assessment Form for school-age children.
  b) Illness: In the event my Child(ren) becomes sick with a contagious illness after visiting any KidsPark location and the visit occurred during the gestation period of such illness, I agree to notify KidsPark as soon as possible to enable KidsPark, in its discretion, to notify each family of all the children who may have been exposed.
5. Medical Procedures:
  a) General Medical Guidelines/Discretion: Although KidsPark tries to provide a safe environment it is possible my child(ren) could get injured. In such event, I authorize KidsPark to follow its internal procedures, including simple first aid as reasonably appropriate; however, I understand KidsPark shall not be required to strictly follow those guidelines when, in its judgment, circumstances may require otherwise.
  b) Medical Authorization: In the event KidsPark determines emergency medical attention is necessary for my Child(ren), KidsPark is authorized by me or whoever signs my child(ren) in for that day, (Authorized Representative"), to act as an agent for me and to give my permission for my Child(ren) to be attended by a physician in such circumstances as KidsPark deems necessary.
6. Safety/Indemnity: I agree that KidsPark may take action which it considers prudent to protect the safety of my Child(ren), and other children visiting KidsPark. I further agree to indemnify, defend and hold KidsPark (and its owners, officers, directors, agents and employees) and its franchises (and their owners, officers, directors, agents and employees) harmless from and against all actions, claims, or liability, including attorney fees and court costs, directly or indirectly caused by my Child(ren) or resulting from any inaccuracy or omission made by me in completing the Registration Form.
7. Photo Release: Click below to indicate whether KidsPark has permission to use without limitation as to time, method or reproduction, photographs produced from my child(ren)’s participation in activities at KidsPark for publications, exhibits, promotions, KidsPark web pages and other family marketing media approved by KidsPark.
8. State of Kansas Licensing Requirements (K.S.A. 65-512 Inspections): It is hereby made the duty of the Secretary of Health and Environment to inspect or cause to be inspected at least once every 12 months every child care facility, and for that purpose it shall have the right of entry and access thereto in every department and to every place in the premises, shall call for and examine the records which are required to be kept by the provisions of this act and shall make and preserve a record of every inspection. The licensee shall give all reasonable information to the authorized agent of the Secretary of Health and Environment and shall afford every reasonable facility for viewing the premises and seeing the children therein. No such child without the consent of the child shall be required to be interviewed by an agent unless the agent is an authorized person or a licensed physician.
9. <strong>Immunizations- Check one.</strong>
  I attest that immunizations are current or are in progress for my child(ren). I attest, under penalty, that to the best of my knowledge, the information is true and correct.
  
  My child is exempt under the law from immunizations. As the Parent or Legal Guardian, I state that I am an adherent of a religious denomination whose teachings are opposed to immunizations.
10. Additional Requirements:
  a) My child will not be allowed to leave KidsPark without being escorted by the parent(s), person authorized by parent(s), or facility personnel.
  b) As a condition to my use of the services, I have accurately completed and signed the Registration Form and Release. I acknowledge it is my responsibility to keep my child(ren)'s records current to reflect any significant changes as they occur, e.g., telephone numbers, work location, emergency contacts, child(ren)'s physician, child(ren)'s health status, allergies, and, if required, immunization records. I understand that KidsPark will rely on this information in caring for my Child(ren).
  c) I agree to pay all cost and attorney fees arising out of any action relating to this Agreement, the Registration Form or the Release for collection purposes or otherwise.
11. Privacy Policy: I have been given access to KidsPark's Privacy Policy (click to view KidsPark's Privacy Policy).
  I acknowledge I have reviewed KidsPark's Privacy Policy and understand its contents.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Signed by Elizabeth Sileo
Signed On: July 3, 2025

Timestamp

Audit

September 12, 2024 12:31 pm PDT

{{gravity-field-id-62}}-Olathe Admission Uploaded by Elizabeth Sileo - olatheks@kidspark.com IP 76.133.233.146