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529 Willow Avenue
Hoboken, NJ, 07030
United States

201-253-0449

Preschool Prep form

Please fill in the form below to complete your registration for the Preschool Prep drop off class

Child's Name *
Child's Name
Parent's name *
Parent's name
Parent's Phone Number *
Parent's Phone Number
Nanny's Name
Nanny's Name
Emergency Contact *
Emergency Contact
Emergency Contact's Phone number *
Emergency Contact's Phone number
Permission to assist your child using the bathroom if they need help : *
Has your child ever had an EpiPen administered? If so, please list the dates.
Request for EpiPen administration *
I am requesting and give permission for a non-medical person at Hugs & Bugs Club to administer epinephrine via pre-filled auto-injector mechanism, EpiPen, to my child when needed and a medical professional in not present. I have provided epinephrine via pre-filled auto-injector mechanism properly labeled and in the original container, with the child’s name, dosage, etc., on the pharmacist’s label. It is my responsibility to ensure that the medication carried by the child has not reached its expiration date. I will transport all medication to and from Hugs & Bugs Club drop off class. I am required to counsel Hugs & Bugs Club staff in person, prior to the first drop off class on how the epinephrine via pre-filled auto-injector mechanism should be used in the event my child experiences a life-threatening condition that requires an immediate response to specific symptoms that if left untreated may lead to potential loss of life. I am also required to explain the signs and symptoms of anaphylaxis my child has, if ever, experienced in the past. Further, I am required each 4 weeks to review the use of the EpiPen with all staff at Hugs & Bugs Club. I understand that when epinephrine is administered to my child, 911 will be called and EMS will transport my child to the hospital. I hereby agree to indemnify and hold harmless Hugs & Bugs Club and its employees/agents from any and all losses, claims, injuries, damages or expenses arising out of, or connected with, the administration of the medication by a non-medical person.
Please bring to class the following: *
Class photos *
Class photos
We love sharing your little bug's experience in our classes and give you lots to chat about after class. We share photos using iCloud photo sharing.
Medical release *
DROP OFF REGULATIONS AND MEDICAL RELEASE. I understand that drop-off programs provide temporary child-care services and that as the parent of the visitor, I must be reachable at all times. I will pick up my child at the appointed time in accordance with the schedule and I understand there will be an additional fee for late pick-up. In case of emergency or serious illness, I hereby authorize Hugs & Bugs Club to obtain emergency medical care and/or provide emergency medical transportation for my child/children. I give Hugs & Bugs Club permission for my child to be given CPR and first aid treatments. Further, I understand that all medications for emergency care must be provided by the Parent and written instructions must be given prior to beginning the program. If this includes administering an Epipen, I am responsible for obtaining and maintaining an Epipen for my child, giving full written instructions for use, and give permission for staff to treat my child with Epipen device if such an event occurs. I hereby agree to indemnify and hold harmless Hugs & Bugs Club and Hugs & Bugs Club employees/agents from any and all losses, claims, injuries, damages or expenses arising from the administration of the Epipen device to child. I/we, as parent, will be responsible for payment of any medical expenses incurred. I understand that it is my responsibility as Parent/Caregiver to maintain accurate records of file and inform Hugs & Bugs Club of any changes to medical records and information.
Waiver/Medical/Publicity Release - please read: *
PRIVACY We wholeheartedly respect you and your child's privacy. We love to share what we do in class because they come with lots of smiles and inspiration! We regularly post pictures and how-to's on social media with hopes of sharing creativity. If at any time you would like to opt out of the picture taking and social media sharing, please let us know as soon as possible. TERMS OF SERVICE Please read the following carefully. I certify that I am the parent/caregiver/guardian of child attending Hugs & Bugs Club class and/or drop off program and agree to the following in relationship to the services that Hugs & Bugs Club provides. I understand and agree to the terms of service. RELEASE AND WAIVER OF LIABILITY. I recognize that there are hazards and risks connected with sensory playgroup. I further recognize that there are hazards and risks connected with various materials, objects and food used for sensory play. I agree to participate or designate a responsible adult to participate with my child throughout his/her Hugs & Bugs Club activities. I understand and agree that in case of an allergic reaction, I am solely responsible for attending to and treating my child. Hugs & Bugs Club does not carry Epipens and as such, I am responsible for obtaining and maintaining, carrying at all times and administering the Epipen if such an event of allergic reaction occurs. Further, I understand that if my child is attending the "Drop off" program, I am responsible for obtaining and maintaining an Epipen for my child, giving written instructions for use, and give permission for staff to treat my child with Epipen device if such an event occurs. I hereby except, release and hold harmless Hugs & Bugs Club, and its officers, agents, employees and volunteers, from any and all claims or causes of action arising out of personal injuries suffered by my child during the course of play. I further acknowledge that the I am responsible for the safety of my child I have brought to the various Hugs & Bugs Club locations/facilities (529 Willow Avenue Hoboken, NJ 07030, Mason Civic League 1200 Washington Street ). I further agree to defend, indemnify and hold harmless Hugs & Bugs Club against any loss, damage or expense incurred by reason of any claim or liability based upon personal injury or property damage arising out of the action of parent/guardian or his/her child. I further acknowledge that Hugs & Bugs Club "classes" are strictly Mommy and Me classes and NOT a “drop-off” class for open play. I acknowledge that an authorized adult over the age of 18 must be present and/or responsible for my child at all times. Outside toys, beverages and/or food must be kept in my stroller or bag in an effort to maintain a safe environment at Hugs & Bugs Club. Caregivers must wear socks and failure to do so results in not attending the class. DROP OFF REGULATIONS AND MEDICAL RELEASE. I understand that drop-off programs provide temporary child-care services and that as the parent of the visitor, I must be reachable at all times. I will pick up my child at the appointed time in accordance with the schedule and I understand there will be an additional fee for late pick-up. In case of emergency or serious illness, I hereby authorize Hugs & Bugs Club to obtain emergency medical care and/or provide emergency medical transportation for my child/children. I give Hugs & Bugs Club permission for my child to be given CPR and first aid treatments. Further, I understand that all medications for emergency care must be provided by the Parent and written instructions must be given prior to beginning the program. I am responsible for obtaining and maintaining an Epipen for my child, giving full written instructions for use, and give permission for staff to treat my child with Epipen device if such an event occurs. I/we, as parent, will be responsible for payment of any medical expenses incurred. I understand that it is my responsibility as Parent/Caregiver to maintain accurate records of file and inform Hugs & Bugs Club of any changes to medical records and information. RULES AND REGULATIONS. I acknowledge that Hugs & Bugs Club operates under rules and regulations established for the safety and protection of its members. Pictures/videos will be taken of the children engaged in the Company’s services. Hugs & Bugs Club and its agents reserve the right to take and utilize photographs, videos, or any type of recordings of participating children and their parents, caregivers, or anyone accompanying them to Hugs & Bugs Club while engaged in our classes or associated activities. I consent to Hugs & Bugs Club use of the photographs, videos, or recordings of my child, me, or the guardian I have designated for advertising, promotional, or related purposes, and waive all rights to compensation and other rights which may arise as a result (including any rights under N.Y. Civil Rights Law 50). I understand and agree that the email address(es) I have provided herein will be added to the distribution list for Hugs & Bugs Club. I will note below if my child’s image should be excluded from use. Hugs & Bugs Club guarantees a full refund if notified 24 hours after original purchase. One make-up class is permitted per session and must be used within the session. Make-up classes are permitted during active enrollment, contingent to availability and upon express and specific consent of Hugs & Bugs Club. Makeups cannot be added up or used to prorate another session. All make-ups must be used during active enrollment of a semester. Hugs & Bugs Club reserves the right to cancel classes due to low enrollment. All checks must be made payable to Hugs & Bugs Club for the full amount of the session's fee at the beginning of the first day of class. Your child's spot will not be confirmed in the class until payment and application are received. In the event of a bounced check or insufficient funds a service fee of $25 will be incurred. Facilities, equipment, hours, service, regulations and policies are subject to change from time to time, without prior notice, in the sole discretion of Hugs & Bugs Club with its members enjoyment in mind. I agree to accept such reasonable change(s) as a condition of membership. As parent/guardian, I understand that I am entitled to use the Facility within the scope of the membership that I have selected. I certify that I have read the foregoing Membership Agreement, I acknowledge that I understand and agree to be bound by all of the terms and conditions hereof.
I understand the makeup policy *
One make-up class is permitted per session and must be used within the session. Make-up classes are permitted during active enrollment, contingent to availability and upon express and specific consent of Hugs & Bugs Club. Makeups cannot be added up or used to prorate another session. All make-ups must be used during active enrollment of a semester.
Refund Policy *
Hugs & Bugs Club guarantees a full refund if notified 24 hours after original purchase.
Electronic Signature *
By selecting the "I Accept" checkbox, I am signing this agreement electronically. I agree this electronic signature is the legal equivalent of my manual signature on this agreement.
Please type your name below to sign this form.