We need an agreement once a school year from every parent participating

TODDLER GYMTIME AGREEMENT

For Enrolled Parents and Children

Toddler Gymtime is a parent-facilitated interactive gross motor activity program for parents and their children.  It sponsored by the Family Resource Center of Truckee at Sierra Mountain Community Education Center (SMCEC), which is part of Tahoe Truckee Unified School District (TTUSD).  The equipment is geared for children in the general age range 1-3 years old.  Since this class is self-facilitated, there is no charge for the class.   

The Family Resource Center will:

• Provide the use of the gymnasium at SMCEC;
• Provide developmental equipment for the parents to select for their children’s use;
• Provide sanitizing products to clean hands and equipment.

Parents agree to:

• Attend the program with their children;
• Supervise their children at all times during the program;
• Choose equipment for their children, clean after use and put equipment away;
• Assume full responsibility for their children’s health and safety during the program.

Because Toddler Gymtime is voluntary and fully parent-supervised, and because any activity with games and athletic competition, physical contact and physical exertion, involves some element of risk, Parents agree that the Family Resource Center and TTUSD are not financially responsible or otherwise liable for any personal injury or death, or for the loss of or damage to any personal property arising out of, during, or in connection with Toddler Gymtime.

Name of Parent(s):  ____________________________________________________

Address of Parent:  ____________________________________________________

Phone Number:  _____________________     Email Address:  _________________

Name of Child(ren): _______________________   Birth date:   _________________   

                                  _______________________                        _________________

                                  _______________________                        _________________

Ethnicity of Parent__________________Language spoken at home____________

Ethnicity of Child(ren)_______________Language spoken at home____________

Number of Adults in the Household:  _______

Number of Children in the Household:  _____

Have you ever received services at the Family Resource Center other than these classes?  Yes______    No______

Parent Signature:  _______________________________   Date:  _______________