Rochester Athletic Club
Babysitter/Nanny Registration
Today’s Date:
Member #:
Member Name:
BABYSITTER: $35.00/YEAR (Registration and replacements are valid from
May 1, 2015-April 30, 2016).
The RAC’s definition of a Babysitter is to supervise the child(ren) during their use of the
facilities and services and while they participate in any activities. They are NOT allowed
access to the club without the child(ren).
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Spouse and siblings are NOT eligible.
Grandparents or other relatives serving as Babysitters must be approved by Management.
Must be at least 13 years of age and at least three years older than the eldest child.
There is no charge for adding an existing member who will function as your
Babysitter(Member #:
)
Maximum of four babysitters per membership.
Babysitter is NOT allowed to check child(ren) into the Kids Club or Neighborhood.
By signing below, I acknowledge that the caregiver I am listing meets the requirements
listed above as a Babysitter.
Member’s Signature:
NANNY: $35.00/MONTH
The RAC’s definition of a Nanny is a LIVE-IN childcare provider. A Nanny will have full
club privileges as part of the family’s membership.
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Spouse and siblings are NOT eligible.
Grandparent or other relative serving as a Nanny must be approved by Management.
Must be at least 18 years of age and three years older than the eldest child.
Must reside at the member’s residence and employed as a full time Nanny.
Maximum of one Nanny per membership.
By signing below, I acknowledge that the caregiver I am listing meets the requirements
listed above as a Nanny.
Member’s Signature:
“NEW” BABYSITTER INFORMATION - $35.00/YEAR (FOR MAY 1, 2015-APRIL 30, 2016)
APPLICATION ON BACK
Name:
Member #:
Birthdate:
Age:
Effective Date:
“REPLACEMENT” BABYSITTER - $25.00 administrative fee for replacement during the remainder
of 12 month period
Current Babysitter’s Name:
Replacement Babysitter:
Birthdate:
Age:
Effective Date:
PERMISSION TO CHARGE GOODS AND/OR SERVICES: I give my permission for the
babysitter named above to charge goods and/or services towards the membership account and
accept full responsibility for payment of all charges made by this babysitter on the account.
Y / N
INITIALS
“NEW” NANNY INFORMATION - $35.00/MONTH
Name:
Birthdate:
Age:
Effective Date:
“REPLACEMENT” NANNY - $25.00 administrative fee for replacement during the remainder of the
12 month period plus $35.00/month charge
Name:
Birthdate:
Age:
Effective Date:
PERMISSION TO CHARGE GOODS AND/OR SERVICES: I give my permission for the
Nanny named above to charge goods and/or services towards the membership account and
accept full responsibility for payment of all charges made by this Nanny on the account.
Y / N
INITIALS
RELEASE OF LIABILITY: By signing below, I acknowledge that the use of the services, activities and facilities of the
Rochester Athletic Club carries a risk of serious personal injury and/or death. As consideration for my child(ren) being
permitted to use the facilities and services as well as participate in the activities of the Rochester Athletic Club while
under the direct supervision of the temporary guardian named above, I EXPRESSLY AGREE TO ASSUME ALL RISK
OF SERIOUS INJURY AND/OR DEATH, AND TO RELEASE THE ROCHESTER ATHLETIC CLUB, it’s officers,
directors, employees, agents, successors and assigns (“the Released Parties”) from liability for injuries, damages or
other loss caused by THE NEGLIGENCE OR STRICT LIABILITY of the Released Parties. I do not release them from
liability for willful or intentional conduct or punitive damages. I also understand that this Release applies to each and
every use my child(ren) may make of the Rochester Athletic Club, under the care and supervision of the temporary
guardian named above.
I acknowledge the Rochester Athletic Club reserves the right to amend the provisions governing the Babysitter/Nanny
Policy at any time. I have read this form carefully and understand all of its terms and conditions. I sign it voluntarily and
without any reservations.
Member’s Signature:
Nanny/Babysitter’s Signature:
Associate’s Signature:
Please place in Accounting’s mailbox when complete.
Updated: 4/8/15