Palaestra Application Form

Crenshaw School Year Palaestra Application

Complete the form (including electronic signature), then submit the application. Please note that this does not guarantee a spot for you child.
Last Name*
Parent 1*
Parent 2
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number*

Area CodePhone Number
Work Phone Number*

Area CodePhone Number
Mobile Number*

Area CodePhone Number
Secondary Mobile Number

Area CodePhone Number
Primary Email*
Secondary Email
** Registration fees and deposits are non-transferable and non-refundable.

** Please refrain from asking for children to be grouped with siblings or friends.

** Children who are three and older must be potty trained to attend class.
First Child's Information
Last Name*
First Name*
Sex*
Birth Date*

MonthDayYear
Current Age*
This Application is for School Year Palaestra Preschool Only not Summer Palaestra.
Term*
Class Days*
Special Information Concerning Child:
Second Child's Information
Do you have a second child?

NoYes
Last Name
First Name
Sex
Birth Date

MonthDayYear
Current Age
This Application is for School Year Palaestra Preschool Only not Summer Palaestra.
Term*
Class Days
Special Information Concerning Child:
Emergency Information
Doctor's Name*

First NameLast Name
Doctor's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Hospital*
Please Read and Sign
All precautions will be taken to prevent injuries. Simple first aid will be administered to all minor injuries and parents and/or doctors will be called when necessary. However, in the event that Crenshaws must make arrangements for emergency medical attention at the time of illness or accident, I hereby authorize Crenshaws to take my child the above Doctor or Hospital. In return for the use, today and on all future dates, of the property, facilities and services (the "Facilities") of Crenshaw Athletic Club ("Crenshaws"), the undersigned, for himself/herself, and on behalf of his/her children, heirs, assigns, and legal representatives, hereby expressly agrees to:

(1) ASSUME ANY AND ALL RISKS TO HIMSELF AND HERSELF AND/OR MY/OUR CHILDREN INVOLVED IN OR ARISING FROM OR MY USE OR MY CHILD'S USE OF OR PRESENCE UPON THE FACILITIES, INCLUDING, WITHOUT LIMITATION, THE RISK OF BODILY INJURY, PROPERTY DAMAGES OR DEATH. I/WE HEREBY AFFIRM THAT I/WE UNDERSTAND THE INHERENT HAZARDS OF ACCIDENTAL INJURY IN CONNECTION WITH ACTIVITIES OR BEING ON THE FACILITIES. I/WE UNDERSTAND THAT ANY ACTIVITY WHICH INVOLVES HEIGHT, MOTION OR WATER CREATES THE POSSIBILITY OF ACCIDENTAL INJURY. I/WE ARE FULLY AWARE OF AND APPRECIATE THE RISK OF CATASTROPHIC INJURY, PARALYSIS, AND EVEN DEATH AS WELL AS OTHER DAMAGES AND LOSSES ASSOCIATED WITH THE PARTICIPATION AT CRENSHAWS AND/OR BEING ON THE FACILITIES.

(2) RELEASE CRENSHAWS AND ALL OF ITS SUCCESSORS, ASSIGNS, SUBSIDIARIES, OFFICERS, DIRECTORS, EMPLOYEES AND AGENTS FROM, AND AGREE NOT TO SUE THEM ON ACCOUNT OF OR IN CONNECTION WITH ANY CLAIMS, CAUSES OF ACTION, INJURIES, DAMAGES, COSTS OR EXPENSES ARISING OUT OF MY/OUR OR MY/OUR CHILD'S USE OF OR PRESENCE UPON THE FACILITIES, INCLUDING, WITHOUT LIMITATION, THOSE BASED ON DEATH, BODILY INJURY OR PROPERTY DAMAGES; WHETHER OR NOT CAUSED BY THE NEGLIGENCE OR OTHER FAULT OF CRENSHAWS, OF ITS AGENTS, EMPLOYEES, OR SERVANTS, WHETHER PAID OR VOLUNTEERS.

(3) INDEMNIFY, HOLD HARMLESS, AND DEFEND, AT MY/OUR OWN COST, CRENSHAWS, ITS AGENTS, EMPLOYEES AND SERVANTS FROM ANY AND ALL LIABILITY, DAMAGES, LOSSES, CLAIMS, JUDGMENTS, COSTS OR EXPENSES, INCLUDING ATTORNEY'S FEES, WHICH IN ANY WAY ARISES FROM MY/OUR OR MY/OUR CHILD'S USE OF OR PRESENCE UPON THE FACILITIES, IRRESPECTIVE OR WHETHER SUCH LIABILITY, DAMAGES, LOSSES, CLAIMS, JUDGMENTS, COSTS OR EXPENSES WERE ACTUALLY OR ALLEGEDLY CAUSED WHOLLY OR IN PART THROUGH THE NEGLIGENCE OF CRENSHAWS OR ANY OF ITS AGENTS, EMPLOYEES OR SERVANTS, WHETHER PAID OR VOLUNTEERS
Read above and Check Below*

I have read and understand this agreement. I also understand a copy of this agreement will be made available for me at my request.
Parent Signature*
Parent Name*
Date*

MonthDayYearHourMinutesAM/PM Option
COVID 19 Policy

Updated 7/1/2021
Initial Here*   I understand that to enter upon the facility premises my child must be free from COVID-19 symptoms. If, during the day, any of the following symptoms appear my child will be separated from the rest of the people in the center. I will be contacted, and my child MUST be pick-uped from the facility within 30 minutes of being notified.

Symptoms include,
-Measured temp greater than 100.0 degrees F
-Cough
-Shortness of breath or difficulty breathing
-Chills
-Headache
-Sore throat
-Lost of taste or smell
-Diarrhea
-Known close contact* with a person who is lab confirmed or suspected to have COVID-19.

While we understand that many of these symptoms can also be related to non-COVID-19 related issues we must proceed with an abundance of caution during this Public Health Emergency. These symptoms typically appear 2-7 days after being infected so please take them seriously. Your child will need to be symptom free without any medications for 24 hrs before returning to the facility. If your child has been in close contact with someone who has tested positive they must remain at home until they are cleared by APH to return. If you consult with the office after the exposure we will help you with your specific child's timeline. Your child must also remain home while a family member is awaiting results of a COVID test.

Initial Here     I understand Crenshaws will not require Masks for individuals who have been fully vaccinated. I understand that if I am not fully vaccinated I will continue to wear a mask while in close proximity to others.

Initial Here   I understand that the kids will be encouraged to wear masks while in camp. I understand that there will be times including eating, drinking, swimming, playing outside, etc where masks will be optional while at camp. This policy is inline with CDC guidelines and APH

Initial Here        I understand that if I enter the building I will have my temperature taken, clean my hands, wear a mask (if unvaccinated), and be free from signs/symptoms of illness. At this time we would also like to limit the amount of extra people in the building.

Initial Here        I understand that my child will be required to wash their hands using CDC recommended hand washing procedures throughout the day using running water and rubbing with soap for at least 20 seconds.

Initial Here       I will seek COVID-19 testing promptly and immediately notify CRENSHAW ATHLETIC CLUB management if there is a positive test, have any immediate contact with a confirmed positive person or anyone in the household exhibiting signs or symptoms of COVID-19.

Initial Here      Travel: I will notify management if my child travels to a "hot spot" area and understand that Crenshaws reserves the right to ask that we remain out of the program for a period of 1 week-14 days prior to returning.

Initial Here      I understand that while present in the facility each day my child will be in contact with children, families, and other employees who are also at risk of community exposure. I understand that no list of restrictions, guidelines or practices will remove 100% of the risk of exposure to COVID-19 as the virus can be transmitted by persons who are asymptomatic and before some people show signs of infection. I understand that I play a crucial role in keeping everyone in the facility safe and reducing the risk of exposure by following the practices outlined herein

l,    First Name   Last Name, certify that I have read, understand and agree to comply with the provisions listed herein. I acknowledge that failure to act in accordance with the provisions listed herein, or with any other policy or procedure outlined by CRENSHAW ATHLETIC CLUB will result in termination of services. I acknowledge that care for my child will be terminated if it is determined that my actions, or lack of action unnecessarily expose another employee, child, or their family member to COVID-19.

Parent Signature      Signature*
Have you had a change in address in the last year?*
Additional Comments?
Please Check Below*

After summiting this application you MUST call Crenshaws with payment. If you do not call with payment your application will not be completed and you could lose your spot.
How did you hear about us?*

Currently EnrolledReturning StudentOther ChildParents used to be at CrenshawsElsass AcademyHighland Park Elementary PE ClassGoogleYahooBingYelpFacebookYellow PagesA friendHP WestWord of MouthOther
Should be Empty:

Crenshaw School Year Palaestra Application

First Child's Information

Second Child's Information

Emergency Information

Please Read and Sign

COVID 19 Policy