ENROLLMENT AGREEMENTS (when applicable):
Field Trip Release: The parent/guardian hereby gives authorization for their child to participate in
field trips sponsored by Winchester Parks and Recreation Department. Transportation is provided by
City of Winchester Public School bus, Winchester Transit System or Winchester Parks and Recreation
COMMUNICABLE DISEASE: The parent/guardian agrees to inform program staff within 24 hours
or the next business day after his/her child or any member of the immediate household has developed
any reportable communicable disease, as defined by the State Board of Health, except for life
threatening diseases which must be reported immediately.
ILLNESS NOTIFICATION: Winchester Parks and Recreation Department Staff will do a daily health
assessment on each child enrolled. If a child develops a fever or becomes ill during the day,
parent/guardian will be notified to pick up their child. Staff will have parents sign form at pick up.
Child may return once fever and symptoms are no longer present or a doctor’s note is received stating
their return date to the program.
MEDICAL/EMERGENCY RELEASE: Parent/Guardian gives authorization and consent to
Winchester Parks and Recreation Department Staff to administer general first aid treatment for his/her
child for minor injuries or illnesses. If the injury or illness is severe, parent/guardian authorizes
Winchester Parks and Recreation Department Staff to seek professional emergency personnel to attend,
transport, and treat his/her child and to issue consent for any medical care deemed advisable by a
licensed medical professional or hospital. Parent/Guardian authorize the designated Winchester Parks
and Recreation Department Staff to exercise best judgment upon the advice of medical or emergency
personnel. Winchester Parks and Recreation Department Staff will accompany the child to the hospital
until parent/guardian arrives. If there is an objection to obtaining emergency medical treatment,
Parent/Guardian must give a written instruction plan to be kept on file to administer the adequate
care for his/her child.
PHOTO PERMISSION: I ____give or ____ do not give permission to Winchester Parks and Recreation
Department to take my child’s photo for use of promotional materials. These materials may be but are
not limited to, program slide shows, activity guide, fliers, and social media.
SUNSCREEN/BUG SPRAY: I give my permission for the Winchester Parks and Recreation
Department Staff to apply sunscreen and/or bug spray to my child(ren).
Any known adverse reactions:_____________________________________________________________
o Check here if you DO NOT want sunscreen/bug spray applied
PERMISSION/LIABILITY RELEASE: I hereby acknowledge that I have read and understand all of
the above, and have supplied all of the information requested to the best of my knowledge. I also agree
to adhere to all of the policies listed in the parent handbook and understand that I will be notified of
any changes. I recognize all of this and give my permission for all of the above and also my approval
for participation in any and all events and activities associated with the programs. I assume all risks
and hazards incidental to such participation and I waive, release, absolve, indemnify and agree to hold
harmless the City of Winchester and the Winchester Parks and Recreation Department for any
accident, illness, or injury to my child or caused by my child to others where neglect is not a factor.
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