Once you submit this form, you will receive a confirmation email from [email protected]. If you do not receive an email within an hour please let us know.
If there is no second parent please put N/A in the following fields.
If you have any questions, comments or concerns, Ashley, Susan or Ilysia would be happy to speak with you. You can get in touch with any of them by email or calling 561 501-6615.
(NOT A PARENT/GUARDIAN) Persons to be contacted in case of illness, accident or emergency, if for some reason the parents or guardians cannot be reached, and authorized to remove the child from the facility. This cannot be either parent one or two, and should be someone within driving distance of Sunflower.
Please help us get to know your family better by providing the following details. Thank you
Permission for Food-related Activities & Special Occasion Food Consumption
Pursuant to 65C-22.005(1)(c)2., F.A.C., licensed child care facilities must obtain written permission from parents/guardians regarding a child’s participation in food related activities. These activities include such things as: classroom cooking projects, gardening, school wide celebrations, and birthdays.
to participate in food related activities and special occasions wherein food is consumed, subject to the conditions indicated below.
Permission for Application of Topical Lotions, Sprays and Ointments
What is Sting Stop?
What is Arnica?
Permission for Administration of Oral Arnica and Benadryl
Sunflower Creative Arts Photo/Video Release
I/We hereby give to Sunflower Creative Arts, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents and employees, the right to reproduce in any of its printed and online publications (such as newsletters, annual reports, websites, social media posts and blog posts), as well as any media that has yet to be created, all pictures, audio and video that it has produced of myself and/or my child(ren).
I/we authorize Sunflower Creative Arts to use all such pictures, audio and video and duplicates thereof, in perpetuity, for its publicity purposes and dispose of them as they may see fit. I/we hereby release Sunflower Creative Arts, from all claims of every kind on account of such use.
Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select the "I Accept" button constitutes your signature acceptance and agreement as if actually signed by you in writing.
Questions should be directed to Sunflower Operations and Development Director, Ilysia Shattuck, at [email protected] or 561 501-6615.
Sunflower Creative Arts Release and Waiver of Liability
“Sunflower” means Sunflower Creative Arts, Inc., a Florida not-for-profit corporation, its officers, directors, volunteers, employees, representatives, agents and assigns. “Sunflower Activities” means any and all events, classes, programs, and/or services, formal and informal, offered and/or provided by Sunflower.
In consideration of participation in any Sunflower Activities, you, as a parent or guardian, on behalf of yourself and your child/children, waive, release and forever discharge any and all rights and claims for injuries, damages, losses, demands, recoveries, suits, payments, actions, and judgments of every nature and description, against Sunflower for injuries sustained or suffered by you and/or your child/children during any Sunflower Activities.
You hereby agree to hold Sunflower harmless and faultless for any harms or injuries that arise out of or are in any way related to Sunflower Activities and/or your participation and/or your child’s/children’s participation in Sunflower Activities, even if arising from the actions, acts of omission, negligence and/or gross negligence of Sunflower.
You on behalf of yourself and/or your child/children hereby knowingly and freely assume any and all risks of injury, known or unknown, from participating in any Sunflower Activities including but not limited to: physical injury, psychological or emotional injury, paralysis, or death.
You hereby certify that you are legally capable and competent to understand and execute this release and waiver of liability agreement without coercion on behalf of yourself and/or your child/children.
You hereby represent that you and/or any child or children in your care who will participate in any Sunflower Activities are physically, mentally and emotionally fit to participate in Sunflower Activities.
You hereby certify that you have read and fully understand this release and waiver of liability agreement and you understand that you are giving up important rights for yourself and/or your child/children.
You are free to agree or not agree to this agreement by choosing not to participate and/or to not permit your child/children to participate in Sunflower Activities. You have the right to discuss this agreement with Sunflower prior to participation.
You and/or your child/children, by participating in Sunflower Activities, consent to and grant Sunflower Creative Arts, Inc. license to use your and/or your child’s/children’s likeness(s), voice(s), and/or name(s), without compensation, for use in any and all media, whether now known or hereafter devised, in perpetuity, and you release Sunflower Creative Arts, Inc., its successors, assigns and licensees from any and all liability in relation to all of said uses.
You agree to follow and adhere to all Sunflower rules and understand and agree that you may be asked to leave at any moment and for any reason without any effect to the validity of this agreement.
You understand and agree that your and/or your child’s/children’s participation in Sunflower Activities indicates that you hereby waive your rights and/or the rights of your child/children to sue or bring other legal action against Sunflower as stated above and to hold Sunflower harmless as stated above.
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