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Baby Floor Time

For parents/caregivers with babies 12-24 months

Mondays, April 18 - June 13, 2022 No class 5/30 (Memorial Day)
 
8-week session

9:30am-10:45am

*This class is expected to fill to capacity*

Location: Held outdoors in the flat, gated area behind the Secure Beginnings Center

555 Mahoney Ave Ojai CA 93022.
Enter the large main gate to the Oak View Park and Resource Center, walk back toward the library. We meet in the gated area to the left, behind the state preschool.
 

So that we can aggregate data for use in grant applications to receive funding for our programs and scholarships,  we are asking for the following demographical information.

Fields marked with a are required fields.  

Primary Caregiver
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

(mm/dd/yyyy)
Partner/Secondary Caregiver

First Name
Last Name


(mm/dd/yyyy)
Child Information
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First Name
Last Name
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(mm/dd/yyyy)
Household Information
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*
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Payment
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$
COVID-19 Mitigation Policy and Waiver

In consideration of my participation in this activity, I acknowledge and agree to the following:

SELF-SCREENING:
To protect our community from illness, I will refrain from coming to class if (1) anyone in my household has COVID or has had close contact with someone who has COVID -or- (2) in the last 24 hours my child or I have experienced any of the following: fever, congestion / runny nose, headache, cough, sore throat, difficulty breathing, fatigue and muscle or body aches, loss of taste or smell, or nausea, vomiting, or diarrhea. I will not attend programs until having a negative COVID test, an alternative diagnosis from a doctor, or 10 days have passed since symptom onset.

 I am fully and personally responsible for my own safety and actions while and during my participation and I recognize that I may be at risk of contracting COVID-19.

With full knowledge of the risks involved, I hereby release, waive, discharge Secure Beginnings, its' board, officers, independent contractors, affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.

 I agree to indemnify, defend, and hold harmless Secure Beginnings from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.

I understand that this policy may be updated during the course of the class series, in adherence with public health guidelines.

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First Name
Last Name
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(mm/dd/yyyy)