2022-2023 HIVE Student Registration

Today’s Date:____________
Child’s Full Name:_______________________________ Birthdate:______________ 
Student’s Preferred Name:_____________________________________________
Gender:_______
Parent/Guardian Names:__________________________________________________________ 
Phone Number (both): ___________________________ 
 Email Address:_______________________________
Mailing Address:_______________________________________________________________
Parent/Guardian Employer: ________________________ Work Phone: ______________________
Parent/Guardian Employer: ________________________ Work Phone: ______________________

Emergency Contact (other than parent/guardian)

Phone Number:
Relationship:

Which day/time would you like your student enrolled in? _________________________

How did you hear about Bizzy Bee?				
❏	Facebook | ❏	Birthday Party/Event Rental  of ______________________________
❏	Friend/Family: ______________________ | ❏	Other: _________________________

Child’s Health History
Physician’s name: ________________________________ Phone #_________________________
List of any known allergies/allergic reactions (food, medication, latex, etc): ____________________________________________________________________________
List of any previous surgeries/date: ___________________________________________________
List of any serious illness/injury: _____________________________________________________
Any physical/ mental/learning delays we should be aware of? _________________________________
Any health concerns we should be aware of? _____________________________________________

This health history is current and correct to my best knowledge, and thus the person described has permission to engage in all activities at Bizzy Bee unless otherwise noted. 

Signature of Parent/Guardian: ______________________________ Date: __________________
Medical Consent Statement
I, the parent/legal guardian hereby give my consent for Bizzy Bee to provide, through a medical staff of its choice, customary medical attentions, transportation, and emergency medical services as warranted to the above named child if I cannot be contacted and a reasonable effort has been made to do so. 

Signature of Parent/Guardian: ______________________________ Date: ___________________
 HIVE Student Registration

ATTENDANCE POLICY
●	If student will be absent please notify us ahead of time if possible.
●	In the case of illness please notify us ASAP of absence. 
●	If illness is Covid-19 related it will follow guidelines of Bizzy Bee’s Covid Policy.
●	Any student who is ill (vomiting, diarrhea, fever)  should be 24 hour symptom free before returning to classes.

Signature of Parent/Guardian: ____________________________ Date: _______________

PHOTOGRAPHY/VIDEO CONSENT
 I, the parent/guardian, give permission to Bizzy Bee and their authorized personnel to take and use photograph(s) and/or video images of my child for the purposes of publication, promotion, education/training and other similar purposes intended to support or otherwise promote the mission and goals of Bizzy Bee Activity & Learning Center. Such uses may include but are not limited to the right to use such images or visual depictions in printed and online media, including social media. Acknowledging the above, I hereby release and will hold harmless Bizzy Bee Activity & Learning Center, and their authorized personnel and employees from all claims associated with, any claimed liability related to said images or video, and specifically agree that in no case shall Bizzy Bee Activity & Learning Center be held liable for any claims based upon the use or misuse of such images or video. This release does not grant Bizzy Bee Activity & Learning Center or their authorized personnel or employees permission to sell photo or video rights to a third-party or make such images available for any commercial use or purpose.

Signature of Parent/Guardian: ____________________________ Date: ______________

BIZZY BEE CONSENT AND ASSUMPTION OF RISK WAIVER 

In consideration for my/my child’s participation at Bizzy Bee Activity & Learning Center, and being allowed to participate in any center events or activities, the parents/legal guardians of the minor participant named above agrees:
 1. Participant shall be instructed to follow all Bizzy Bee Activity & Learning Center safety guidelines at all times. 
2. I/We fully understand and will instruct the minor participant that:
 A. There are risks and dangers associated with participation in activities including but not limited to those of bodily injury, partial and/or total disability, paralysis and death. 
B. The social and economic losses and/or damages, which could result from those risks and dangers, could be severe. 
C. These risks and damages could be caused by the negligence of participant or the negligence of others. 
D. There may be other risks not known to us, or are not reasonably foreseeable at this time. 
3. I/We agree that this Consent and Assumption of Risk Statement pertains to each and every event or activity sponsored by Bizzy Bee Activity & Learning Center. 

4. I further agree that Bizzy Bee Activity & Learning Center along with its owners, employees, agents, officers and directors shall not be liable for any losses or damages, including any personal injury, occurring as a result of participation in Bizzy Bee Activity & Learning Center events EXCEPT where such loss is the result of the intentional or reckless conduct of any individuals identified above. I further agree to hold harmless and fully indemnify Bizzy Bee Activity & Learning Center, its owners, employees and agents, for any and all losses, damages or claims of any nature which arise out of my child’s participation at Bizzy Bee Activity & Learning Center, in the event a claim is presented to or made against Bizzy Bee Activity & Learning Center.

 I/WE HAVE READ THE ABOVE MINOR CONSENT AND ASSUMPTION OF RISK AND SIGN VOLUNTARILY. 
Signature of Parent/Guardian: ____________________________ Date: _______________