Just For Girls Social Group - Registration Form
Event Timing: September 2018 - June 2019 - 2nd Friday of each month. Our first social is on September 14 2018
All potential applicants must have been previously interviewed or already attended a S.I event before registering.
My Child or myself has been interviewed
My child or myself already attends a Spectrum Insights Event
I would like to be interviewed. Please see the additional comment section at the bottom of this form.
Date Of Birth
Medical Concerns / Conditions
Emergency Contact info
Individuals Authorized to Pick up / Drop Off
Photo Permission - Any photos/videos taken may be used to help promote and document the activities of Spectrum Insights events through our website, Facebook, Twitter and Instagram. Names and personal information of the students WILL NOT be used.
Yes I give permission for my child to be photographed
No I do not give permission for my child to be photographed
Waiver: It is my understanding that an activity of this nature has inherent risks involved. All reasonable precautions for the safety and health of the participant will be taken. He/she will be properly supervised in activities. In the event of accident or sickness, Spectrum Insights, sunnyside Weslyan Church, its staff and volunteers are released from any liability. In the event of injury requiring medical attention, I authorize treatment for the participant and understand that reasonable attempts will be made to contact me, should such a situation occur.Please note this group is not appropriate for any aggressive behaviours or students that may potentially run off. Students must be able to exhibit independence and ability to follow complex group instruction.
I Understand and agree
I understand that I will have to pay $250 in Order to register my Daughter
I understand and agree
Payment can be made to John Anderson Via:
Yes - I am paying $250 for a full time spot
I am registering my daughter for drop in availability - $25 per social
Electronic Fund Transfer:
Cheque made payable to: John Anderson 316 Robillard Pvt Ottawa ON K1T2V8
I will pay Via:
$250 via Cheque to: John Anderson 316 Robillard Pvt Ottawa ON K1T2V8
Electronic Fund Transfer of $250 to:
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