Keweenaw Family Resource Center - Playtime in the Park Registration

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* 1.
General Guidelines

We will be visiting different parks, which may have their own set of rules that we must follow. At times the parks will also have a beach area. It is up to each parent to decide whether or not to allow your child to enter the water.

However, please remember the following:

Parents must accompany child(ren) to activities and are responsible for their child(ren) at all times.

Parents should provide life preservers. It is highly recommended that child(ren) wear a life preserver when in or near the water. Remember that inner tubes and other rafts do not protect children from drowning. While near or in the water there will be no pushing, shoving, splashing or throwing sand.

Parks may not be cleaned or sanitized on a regular basis. Using equipment may expose you to viruses. State of Michigan social distancing guidelines and masking wearing recommendations are strongly encouraged.

Parents waive KFRC, BHK and other sponsors of all responsibility for accidents and illness while families are participating.

Please initial and date below to indicate you have read and agree to the above guidelines.

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* 2. Contact Information

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

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* 3. Emergency Contact Name and Phone Number

Name

Phone Number

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* 4. Names & Ages of Children Attending (if more than 5 children please complete second survey)

Child 1 Full Name:

Child 1 Age:

Child 2 Full Name:

Child 2 Age:

Child 3 Full Name:

Child 3 Age:

Child 4 Full Name:

Child 4 Age:

Child 5 Name:

Child 5 Age:

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* 5. I give the Keweenaw Family Resource Center /Copper Country Great Start Collaborative and/or BHK my permission to take and use pictures of myself and my child on publications and websites.

Yes

No

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* 6. I would like to receive emails containing activities and parenting resources in the community.

Yes

No

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* 7. Total Number of Adults and Children in Your Household (optional - used for grant reporting purposes only)

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* 8. Please select the income level that best describes your household (optional - used for grant reporting purposes only).

less than $16,910

$16,911 to $25,365

$25,366 to $31,283

$31,284 to $42,660

$42,661 to $51,500

$51,501 to $60,340

$60,341 to $69,180

$69,181 to $78,020

More than $78,021