Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Child's Name *

Child 1

First Name

Last Name

Child's Date of Birth *

Child 1

MM

DD

YYYY

Child's Name

Child 2

First Name

Last Name

Child's Date of Birth

Child 2

MM

DD

YYYY

What Play-Group(s) would you like to attend? *

Sign up for one, some, or all!

Wednesday, 11/01 at 9:00-Gadsden Park

Wednesday, 11/08 at 9:00-Gadsden Park

Wednesday, 11/15 at 9:00-Gadsden Park

Waiver *

ROOTED IN PLAY WAIVER OF LIABILITY / ASSUMPTION OF RISK I, for myself, my child/children or ward/wards sign this Waiver and Assumption of Risk in consideration of the opportunity to participate in any activities by ROOTED IN PLAY. I, for myself, my child/children or ward/wards acknowledge and understand that there are dangers and risks associated with the activities by ROOTED IN PLAY and agree to assume all risk of personal injury, including the potential for paralysis and death. I, for myself, my child/children or ward/wards, and on behalf of my or their heirs, assigns, personal representatives and next of kin, HEREBY HOLD HARMLESS ROOTED IN PLAY, its owners, members, officers, employees, equipment manufacturers and sponsoring agencies from all liability for any such personal injury, disability, death or loss or damage to person or property to the fullest extent of the law.

Yes

No

Photo Release *

At Rooted in Play, we believe in the power of play and its positive impact on children's development. As part of our commitment to the well-being and growth of the children who join our playgroups and pop-up events, we document play through photos and videos. These visual records serve several essential purposes: 1. Learning and Discovering More: Through documenting play, we aim to learn and discover more about the children, families, and ourselves. It's a way to delve deeper into the unique qualities, interests, and strengths of each child. This understanding allows us to tailor our playwork practice to better support their individual needs and preferences. 2. Valuing the Importance of Play: We want children to know that what they are doing is important and that their play matters. By capturing their play moments, we reinforce the idea that play is a significant part of their lives and a valuable source of learning, growth, and self-expression. 3. Reflecting on Our Playwork Practice: By capturing moments of play, we can reflect on our playwork practice, continually improving and adapting to better meet the needs of your children. We learn from their play, gaining valuable insights into what encourages exploration and creativity. 4. Providing Learning Opportunities for the Community: We believe that play is a powerful tool for learning and growing. Sharing images and videos from our events offers educational opportunities not only for the children who participate but also for our wider community. Parents, caregivers, educators, and play enthusiasts can gain insights into the world of child-led play and its benefits. I, for myself, my child/children or ward/wards grant ROOTED IN PLAY permission to use myself or my children in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. If you answer "No", please see a Rooted in Play staff member.

Yes

No