PERSONAL DATA
Participants First Name
Last Name
Parent/Guardian Name
Last Name
Participant's Date of Birth
Email/Parent or Guardian Email
Address of Participant
City
State
Zip Code
Home Phone
Cell Phone
How did you hear about us?
Radio
Newsletter
Social Media
Newspaper
Website
Catalog
Friend
(1) Sign Up HERE for the weeks your child will be attending.
(2) Select the box to the right of the week for the number of days your child will attend.
*Year-Round students either already attend Sunshine or expect to attend following the summer.
*To attend for less than 5 days, you must be a year-round student or must sign up for 4+ weeks.
TERMS AND CONDITIONS/ CANCELLATION POLICIES
Release of all Claims and Promise Not to Sue:
As a participant in a program through Berkshire South Regional Community Center(BSRCC), I recognize and acknowledge that there are certain risks and I agree to assume all such risks, including any damage resulting from physical injuries, loss of services or consortium, loss or damage to property, or any other loss I may sustain as a result of participation in any and all activities connected with or associated with such program(s). In consideration of BSRCC accepting my or my child's registration, and with the intent to be legally bound, hereby, for myself, for my child, all heirs, executors, administrators, and assigns, do hereby forever release, waive and relinquish all claims I have or may have as a result of participating in this and all other programs of BSRCC. Furthermore, I promise not to sue BSRCC and agree to indemnify and hold harmless and defend BSRCC and it's officers, agents, servants, employees and insurers from any and all liabilities, claims, demands, actions or causes of action resulting from my or my child's participation in this or any other program(s) at BSRCC.
Liability Waiver
In consideration of being allowed to use the facility, equipment, machinery and/or programs, participant(s) personally assume all risks involved in any exercising, training, activities and/or programs at the Center. Participant(s) recognize and acknowledge that there are certain risks of physical injury involved in undertaking any fitness activity. Participant(s) thereby voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of the severity, that they may sustain as a result of said participation. Participant(s) are solely responsible for determining if they are physically fit and/or adequately skilled for said activity. It is always advisable to consult a physician before undertaking any fitness activity. Please be aware that by signing and/or participating in any Berkshire South activity, participant(s) are expressly assuming the risk, the legal liability, are waiving and generally releasing all claims for injuries, damages or loss which one might sustain as a result of participating in any and all activities connected with and associated with Berkshire South. Participant(s) also waive and release, now and forever, all claims and causes of action against Berkshire South, its elected or appointed officers, agents, volunteers, employees, representatives, consultants, executors, and all others directly or indirectly connected with Berkshire South from any and all: personal injuries (including death), any medical condition of any kind which results, any aggravation of a pre-existing medical condition, and any and all other damages or injuries which may be sustained in any way from the direct or indirect result of activities, exercise, training and participation in the Center. Participant(s) further hold Berkshire South harmless from any loss to personal property which is lost, damaged or stolen at Berkshire South.
Participant Responsibilities
Participant is aware that Berkshire South Regional Community Center is an intergenerational facility open to a diverse population and will act respectfully toward all other members and guests. Participant acknowledges that inappropriate actions by himself/herself, his/her family, or his/her guests could result in their not being allowed to participate in programs. Further, management of the Center may suspend or cancel the rights, privileges of participants whose actions are detrimental to the enjoyment of the Center facilities by other guests, or for failure to comply with Center rules. Participant is aware that any exercise program undertaken may create physical stress resulting in harmful effects. It is solely Participant's responsibility to consult with a physician prior to commencing any exercise program, to remain under medical supervision if that is indicated and to seek medical assistance in the event of injury. Participant recognizes that the use of exercise equipment and other facilities provided by Berkshire South carries some risk of accidental injury to himself/herself and others and agrees to use such equipment and facilities with due care.
Insufficient Funds, Arrears and Default
All checks that are returned with insufficient funds are subject to a $25 fee.
COVID-19 Waiver of Liability
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Berkshire South Regional Community Center (Berkshire South) has put in place preventative measures to reduce the spread of COVID-19. The Center has followed guidance from the CDC, local health agencies and public officials to update policies, practices and procedures to ensure the highest standards of cleanliness and hygiene and make appropriate accommodations for physical/social distancing. Members and guests must come prepared to follow new cleaning procedures which may include cleaning all equipment prior to and after use. However, even with these preventative measures in place, Berkshire South cannot guarantee that members will not become infected with COVID-19. Further, entering Berkshire South could increase my risk of contracting COVID-19. By submitting this agreement, you are acknowledging the contagious nature of COVID-19 and are voluntarily assuming the risk that you may be exposed to and/or infected by COVID-19 and that such exposure or infection may result in personal injury, illness, permanent disability, and death. By submitting, you understand that the risk of becoming exposed to and/or infected by COVID-19 at Berkshire South may result from the actions, omissions, or negligence of yourself and others, including, but not limited to, Berkshire South employees, volunteers, and program participants and their families. By submitting, you voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to yourself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that you may experience and/or incur in connection with attendance at Berkshire South. You hereby release, covenant not to sue, discharge, and hold harmless Berkshire South Regional Community Center employees, agents, and representatives, of and from Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. You understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Center, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after attendance at Berkshire South Regional Community Center.
Sunshine Preschool Enrollment Policy
I understand:
Upon enrollment, there is an annual non-refundable registration fee of $25 per child.
I am financially responsible for the weeks I have chosen for my child.
The balance is due two weeks before my child begins their first session.
There is no reimbursement for sick or canceled days. I am responsible for my commitment to the program.
Pre-registration is required. All forms are due the week before my child’s session begins.
BSRCC is unable to provide care to families with a past due balance of more than 30 days.
E-Signature of Participant or Parent/Guardian
Date
What Happens Next?
Once our Directors receive this form, they will send you additional forms to be completed prior to your child’s arrival.
The following must be submitted at minimum a week before your child is
scheduled to arrive:
A completed Brightwheel Profile
A copy of your child’s immunization records
A copy of your child’s latest physical. Optional: if your child requires any medication, either OTC or prescription,
there are additional required forms that must be provided before arrival
Payment for the week is due two weeks before your child plans to attend
camp for that week.
Payment arrangements can be made with Lucia
Ference at lference@berkshiresouth.org or 413-528-2810 ext. 29
While we prefer that you use our online software, we understand that some
families have limited access. Should you need assistance, we can provide hard copies of our registration packet or a computer for you to complete your forms
online.
If you have any questions regarding your child’s experience or the registration
process, our Associate Director of Childcare Administration is available most
Monday-Fridays from 9:30-2:30 to speak by phone or email at 413-528-2810
x16 or amcpeek@berkshiresouth.org.
Submit