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Nature's Niche OT-Stay Connected 2026
Welcome to Nature's Niche Occupational Therapy: Saturday Morning Groups! We are excited to have your child join us for our nature-based social group.  These groups are designed to provide a supportive environment for children to grow, develop skills, and connect with peers in nature.

Majority of the groups takes place at 20 North Street, Cornwall NY 12518. DROP OFF/PICK-UP at the top of the driveway near the red cabin. If the location is to change for an outdoor adventure communication will occur.

Makeups dates will be offered if a meet up is canceled due to unsafe weather. 

The dates of meet ups will be sent via email.

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Email *
CHILD'S NAME *
CHILD'S DOB *
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I give my child (child's name stated above) permission to participate the Nature's Niche Occupational Therapy's nature-based social group facilitated by Megan Melrose Lucia OTR/L & Laura Baldi OTR/L.  I understand and acknowledge the following:

1. **Nature-based Activities:** My child will engage in outdoor activities such as hiking, climbing, sensory exploration, water play and other nature-based therapeutic interventions.

2. **Risks and Hazards:** I am aware that outdoor activities involve inherent risks, including but not limited to slips, falls, contact with insects or wildlife, allergic reactions, and unpredictable weather conditions.

Supervision:** I understand that I (parent/guardian stated above) will NOT be present with my child during these activities. My child will be supervised by the adult group leaders. However, I acknowledge that accidents and injuries may still occur despite their best efforts.

4. **Emergency medical care** If an emergency arises you give permission for group leaders to call 911. 

5. **Release of Liability:** I (Parents name stated above)-release Megan Melrose Lucia OTR/L & Laura Baldi OTR/L, and volunteers, and affiliates from any liability for injuries, damages, or losses that may arise from my child's participation in the nature-based occupational therapy group.

I have read this waiver and fully understand its contents.

By signing below, I agree to abide by the terms and conditions outlined herein.

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Required
Adults Signature for above waiver *
CHILD'S INFORMATION
Child's Medical and Developmental Information *
DOES YOUR CHILD HAVE ANY ALLERGIES (FOOD, ENVIRONMENTAL)? *
DOES YOUR CHILD HAVE AN IEP (INDIVIDUALIZED EDUCATION PLAN) OR RECEIVE OTHER SUPPORTIVE SERVICES?
DOES YOUR CHILD HAVE ANY SENSORY SENSITIVITIES (i.e. sounds, textures, water etc)?
DOES YOUR CHILD HAVE ANY MEDICAL CONDITIONS WE SHOULD BE AWARE OF? *
Medical Condition explanations/info
WHAT AREAS ARE YOU HOPING CAN SUPPORT YOUR CHILD WITH (i.e. Motor skills, Social interaction, Sensory processing etc).
PARENT'S NAME *
EMERGENCY CONTACT INFORMATION *
Name/Relationship *
Phone Number *
Please make sure your child has water and is dressed appropriately for the weather. We play in the rain, snow, and sun unless safety is a concern. Water shoes and/or rain boots are encouraged. 
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Required
I, the undersigned parent/guardian, give my consent for my child to participate in the Nature's Niche Occupational Therapy Saturday Social Groups. I understand that activities will be outdoors and that appropriate precautions will be taken to ensure my child’s safety. I agree to inform Nature's Niche of any changes to the information provided above.
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Required

**Photography and Media Release:**

 I grant permission for my child's image and likeness to be used in photographs, videos, and other promotional materials related to the occupational therapy program, without compensation.

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Please Sign by typing your full name  *
Today's Date *
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A copy of your responses will be emailed to the address you provided.
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