- Communicate needs

Discipline & Guidance Policy:

- Children are not to take discipline into their own hands!

The Photographic Release allows your child to be photographed and/or videotaped for publicity and advertising purposes only. Check yes or no below to give or decline consent.

ALL children are expected to:

Photographic Release:

Waiver and Release of Claims

It is expressly agreed that all use of the Village of Cuyahoga Heights property, equipment and services, and participation in, or a spectator to, any programs conducted within or on the property of the Village of Cuyahoga Heights and any transportation provided by the Village of Cuyahoga Heights shall be undertaken by me, or my child, or my legal ward at my/his/her sole risk, and the Village of Cuyahoga Heights shall not be liable for bodily injuries or any loss or damage to my/our/their person or property, or to be subject to any claim, demand, injury or damages whatsoever, including, without any limitation, those injuries and/or damages resulting from acts of active or passive negligence on the part of the Village of Cuyahoga Heights, its employees or agents, I, for myself and on behalf of my children, my executors, administrators, legal wards, heirs, assigns and successors, do hereby expressly forever release and discharge the Village of Cuyahoga Heights, its employees, officials, agents, assigns and/or successors from all such claims, demands, injuries, damages, actions or causes of actions whatsoever. It is agreed that I have read and understand all policies and regulations associated with my use of any Village property or equipment or participation in any Village program and agree to abide by all policies thereof. Violations of any Village policy or regulation may result in revocation of this pass.

Youth Events Policy

Our goal with the discipline is that each child develop increasing self-control and the ability to work and play with others. To best understand your child and meet/her needs, parents are asked to communicate to the staff any changes or incidents which may affect the child’s behavior (e.g. divorce or separation; death of a family member, friend, or pet, family or friend moving). All information is kept in the strictest confidence.

- Respect self, others, and property

If a child’s behavior is contrary to these expectations and/or disruptive to others, the Programmer may request a conference with the parent. During the conference, staff and parent will discuss the cause of the inappropriate behavior and how the staff, family, and child can remedy the inappropriate behavior. If the child’s behavior does not improve and all resources are exhausted, OR if that child’s behavior is such that it requires the constant attention of one caregiver, the child may be suspended from the program. Suspension from the program is the last resort of action.

Medical Authorization:

- Comply with program rules and cooperate with staff and other children

In order for medication to be administered by staff, medication must be brought to the Program in its original container with clearly written directions for usage. Parent(s) must also complete a Medication Authorization Form.

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Address

Name of Event

City

ZIP

Phone #

Applicant Details

Email

Last Name

Event Description

State

First Name

Resident Non-Resident

Individual's Details

Resident or Non Resident

Parent/Guardian A:

Last Name

First Name

Phone #

I hereby authorize the Village of Cuyahoga Heights and / or its employees to obtain medical treatment for my child if deemed necessary by the Village of Cuyahoga Heights and / or its employee. I give permission to the medical, dental, or emergency room staff at the facility chosen by the Village of Cuyahoga Heights or its employees to render any emergency medical, surgical, or dental treatment necessary. I understand that any cost incurred for such emergency treatment shall be my sole responsibility. Although reasonable effort shall be made to contact those persons named on this form prior to rendering treatment, none of the above treatment will be withheld if persons cannot be contacted. In the event of any emergency, I understand that my child may be transported to the nearest emergency facility.

Parent/Guardian B:

Middle Name

Phone #

Relationship to Individual

First Name

Emergency Certification

Middle Name

Emergency Contact(s)

Email

Relationship to Individual

Email

Last Name

Authorized Pick Up-Individual

Authorized Pick Up-Child may only be released to the individuals listed below:

Attachments

Add any additional/required documents, if any.

Certification

Signature

Department will reach out with finalized fee for payment.

By signing below, I, the applicant, hereby certify that all of the information provided in this application is true and accurate and that I have read, acknowledged, and understood the Policies and Waiver and Release of Claims provided in this application.

Fees