After School Care Application

Child Care Enrollment

Please fill out all information.

What is your child’s first name?

What is your child’s last name?

What grade was your child in for the 20-21 school year

What is your Childs date of birth

What is your childs age

What is the sex of your child?

Last 4 digits of your child’s social security number

What school does your child currently attend?

Miami-Dade Public Schools ID Number? (if applicable)

Is your child proficient in English

Other languages spoken in your home

Which race/ethnicity best describes your child?

What is your street address?

In what city do you live?

Does the child have health insurance?

YES

What is the name of your medical insurance carrier?

What is the medical insurance carrier number?

List any allergies, illnesses, medicines, behaviours, or other important medical issues that we should know about concerning your child. If there are none, write none

Primary Parent/Guardian's Full Name

Secondary Parent's Cell Number

Primary Parent/Guardian's email address

Is the either parent or guardian a 1st responder or health care professional?

YES

Other

Secondary Parent's Name

Primary Parent/Guardian's Cell Number

Emergency Contact Name

Emergency Contact Relationship to Child

Emergency Contact Number

We want to help your child in the best way possible and grant the best experience. Please tell us the way your child communicates. Check all that apply

What, if any, help does you child receive at this time? Check all that apply

What conditions does your child have that are expected to last for a year or more? Check all that apply

Do any of the conditions marked above make it harder for your child to do things that other children can't do?

Who referred you to the program? (PLEASE STATE THE PERSON'S NAME IF APPLICABLE)

Typing your name in the box below constitutes an electronic signature

Daycare Fee

Price per child: $65.00

How many children

No payment items has been selected yet

I represent that I am the parent/tegal guardian of my child(ren)/ward(s) ("Child"), a minor, and that I hereby agree that I will be bound by all terms of this Attendance Waiver on behalf of my Child. l, the undersigned, on behalf of myself and my Child (together, "Releasors"), do hereby agree as follows. The Releasors hereby release agree to indemnify and hold harmless BeautyWeekend together with its affiliates and respective employees, directors, officers, equity holders, representatives, event sponsors, exhibitors, contractors, and agents together with all of the foregoing, the "Released Parties") of, from, and against any and all actions, proceedings, damages, penalties, claims, demands, causes of action, liabilities, fees (including reasonable attorneys' fees), costs and losses ("Claims") of any kind or nature whatsoever, whether now known or unknown, in connection with, resulting from, or arising out of my Child's presence, attendance of or participation in the BeautyWeekend event, including, but not limited to, without limitation any such Claims for or relating to injury, disease (including COVID-19) or death of any person (incluoing without limitation any of the Releasors) or damage to, or destruction of, any property, whether or not alleged to result from negligence on the part of any of the Released Parties.

This Attendance Waiver is given, and this agreement is made in consideration of and as a condition permitting my Child, when accompanied by me and/or the Child's school, to attend or participate in the Event or to be present in any other capacity whatsoever at the Event. lt is a policy of Beauty Weekend to prohibit admission into the exhibit hall and the conferences to person(s) under 18 years of age without a signed Attendance Waiver. By signing the Attendance Waiver, 1 am certifying that I have read and understood and agree, on behalf of myself and my Child, that all the Releasers will be bound by its terms.

Pay with Card