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Little Sprouts Fall 2020

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(Family Level Membership and Above)
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Family Information
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First Name
Last Name
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Address Line 1
Address Line 2
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Program Policies
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If a family needs to cancel their registration, they must do so in writing to the Education Manager via education@landssake.org. Refunds will only be given if this cancellation is received three weeks before the program date AND the spot is able to be filled by somebody else. Refunds will be prorated based on the number of sessions that have occured, and a $5 administrative fee will be held for all refunds. The Education Manager reserves the right to dismiss a participant when in their judgment the participant's behavior interferes with the rights of others, the smooth functioning of the group or activity, or violates the program's principles of conduct. In such cases no refunds will be given. In the event that our afterschool programs are cancelled due to low enrollment or a change in COVID-19 policy rendering such programs inpermissable by the state, full refunds will be offered. The Education Manager reserves the right to dismiss a participant when in their judgment the participant's behavior interferes with the rights of others, the smooth functioning of the group or activity, or violates the program's principles of conduct. In such cases no refunds will be given. In the event the Land's Sake afterschool program is cancelled due to low enrollment or in the case that state COVID-19 guidelines prohibit such programs, all families will receive a full refund by request.
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I understand that while participating in Land’s Sake programs there are inherent risks, including but not limited to: exposure to the elements, biological irritants (i.e. poison ivy), insects, fatigue, sore muscles, moving vehicles, livestock, and heavy objects. Every reasonable effort will be made to manage these risks and emphasize safe working habits. I understand and accept these risks and will hold Land’s Sake, Inc. and the Town of Weston harmless for any and all injuries suffered in the course of a Land's Sake program.
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The health history I provided is complete to the best of my knowledge. I hereby give permission for Land's Sake staff to provide routine healthcare, administer prescription medication as described, and seek emergency medical treatment. In the case of an emergency, every reasonable effort will be made to contact me. In the event that I cannot be reached, I consent to have the administrators of Land's Sake Education Programs act on my behalf should an emergency arise, and hereby grant permission to authorize medical attention deemed medically necessary by a physician, nurse, or hospital, for which charges I shall be responsible and agree to pay.
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INFORMATION: We will ask all participants to wash their hands before and after each activity. We will ask all participants to wear a fabric face covering or to keep at least six feet of distance between themselves and those not in their family unit. All participants MUST bring a mask that they can comfortably wear, as masks will be required for some activities. Any participant not able to follow these procedures will not be able to participate. LIABILITY WAIVER: Land’s Sake Summer Program COVID-19 Participation Agreement and Waiver: Land’s Sake (“LS” or the “Farm”) is thrilled to be able to provide enrichment opportunities for your child in accordance with orders from the Massachusetts Governor. LS is requiring all participants to read the following warning and sign the liability waiver to participate in programming at the Farm. COVID-19 Warning The World Health Organization has declared the novel coronavirus, COVID-19, as a worldwide pandemic. COVID-19 is extremely contagious and is believed to spread mainly from person-to- person contact. As a result, and in accordance with federal, state, and local regulations, LS has put in place various preventative measures and established protocol to reduce the spread of COVID-19. Despite these measures and the best intentions of LS, LS cannot guarantee that your child will not become infected with COVID-19 as a result of participating in summer programs at the Farm. Further, being present at the Farm could increase risk of contracting COVID-19. ATTESTATION: I attest that: *My child is not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, headache, sore throat, fatigue, congestion, runny nose, nausea, vomiting, diarrhea, or new loss of taste or smell. *I do not believe my child has been exposed to someone with a suspected and/or confirmed case of the COVID-19. *My child has not been diagnosed with COVID-19 and not yet cleared as non contagious by state or local public health authorities. *I am following all CDC and Massachusetts recommended guidelines as much as possible and limiting my exposure to the COVID-19. RELEASE OF LIABILITY FOR MINOR PARTICIPANTS: IN CONSIDERATION OF my child named below being allowed to participate in any way in Farm-related programing, presence at the Farm and use of the Farm facilities, I, for myself, spouse and child, acknowledge and agrees that: 1. The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, 2. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and I understand the contagious nature of COVID-19 and other illnesses, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child/ward’s participation; and, 3. I willingly agree to comply with the Farm’s stated and customary terms and conditions, including but not limited to protocol agreed to at registration. I understand that the Farm may preclude my child/ward from participating in programing or being present at the Farm if my child/ward does not comply with such terms and conditions. If I observe any unusual significant concern in my child’s readiness for participation, I will not permit my child to attend programing and will bring such to the attention of Katrina Goldowsky-Dill; and, 4. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin: HEREBY RELEASE AND HOLD HARMLESS AND AGREE NOT TO SUE the Farm; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct any programing (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, claims, causes of action, and/or loss or damage to person or property incident or in any way related to my child/ward’s involvement or participation in programing or presence at the Farm, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, including with respect to any and all claims related to contracting COVID-19, to the fullest extent permitted by law; and, HEREBY INDEMNIFY AND HOLD HARMLESS AND AGREE NOT TO SUE all the above Releasees from any and all liabilities incident or in any way related to my/my child’s involvement or participation in programming and presence at the Farm, EVEN IF ARISING FROM THEIR NEGLIGENCE, including with respect to any and all liabilities related to contracting COVID-19, to the fullest extent permitted by law; and, 5. I, the parent/guardian, assert that I have explained to my child the risks of the activity, and his/her responsibilities for adhering to the rules in place at the Farm. I, FOR MYSELF, MY SPOUSE, AND CHILD (OR WARD), HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. In the case of an emergency, every reasonable effort will be made to contact me. In the event that I cannot be reached, I consent to have the administrators of Land's Sake Summer Programs act on my behalf should an emergency arise, and hereby grant permission to authorize medical attention deemed medically necessary by a physician, nurse, or hospital, for which charges I shall be responsible and agree to pay.
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I authorize Land’s Sake to take and use photographs, slides, and audio/visual recordings of my child / ward and myself as may be needed for documentation and/or public relations purposes. I understand that all such materials will be the sole property of Land’s Sake.
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