Member Name *

First Name

Last Name

Emergency Contact Cell Phone Number *

(###)

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NEW PROCEDURES RELATED TO COVID 19 *

(subject to change according to Provincial and Grey- Bruce Public Health Unit regulations) For more information about our COVID-19 operating policy please visit the Club Governance section of our website. • All individuals entering the Playrooms (including children, staff and volunteers) will be screened electronically using our Beaver Valley App. Every individual entering the playroom will also have daily temperature checks. • All staff members will be wearing masks, children aged 2 years+ are encouraged to wear masks. • Staff will ensure that all toys used in the Playrooms are made of material that can be cleaned and disinfected regularly (i.e. no plush toys). • Staff will increase the frequency of cleaning and disinfecting objects, toys and frequently touched surfaces. • Staff will incorporate more individual activities or activities that encourage more space between children when appropriate. • Staff will work to spread children out into different areas where appropriate.

I have read the above information

Child #1 *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Is the Child Toilet Trained?

Yes

No

Date of Playschool Program *

MM

DD

YYYY

Date of Après Program

MM

DD

YYYY

Child #2

First Name

Last Name

Date of Birth

MM

DD

YYYY

Is the Child Toilet Trained?

Yes

No

Date of Playschool Program

MM

DD

YYYY

Date of Apres Program

MM

DD

YYYY