Self-Esteem Summer Experience 2022: Registration for Parents/Guardians
Greetings, Parents/Guardians!

I am so excited to invite your precious daughter to participate in the 2022 session of True Love Movement’s Self- Esteem Summer Experience. This year's event is an a fun and interactive THREE days of learning about self-esteem and how our self-esteem impacts our choices.  Our goal is that she makes positive changes and increases her self-esteem!

This experience takes commitment on your child's part as well as your part to support your daughter in her positive transformation. She may be excited about the new things she’s learned. Listen to her, challenge her to think and congratulate her on her new understanding. If we want to see real growth, SHE MUST BE PRESENT FOR ALL THREE DAYS. If you know that you cannot commit to this, please let me know, so we can offer the spot to another girl. Please also be committed to coming to the “graduation”/ Rites of Passage ceremony scheduled on the last day, Saturday July 23, 2022 at 7pm. This is her time to SHINE and be rewarded for what she’s done. True Love Movement’s Self-Esteem Summer Experience will begin at 9 am on Thursday July 21 and each day will end at 3pm (with the exception of Saturday July 22 which will end at 7pm). If before or after care is needed, we can discuss this on an individual basis. The Rites of Passage (will include her parents/guardians and loved ones) on Friday will end at 9 pm. A healthy lunch and snack will be served each day. Transportation will not be provided. This experience is FREE if all registration forms and documents are signed. (Parent/Guardian + Participant).  If you have any questions please feel free to call/text me at 334-531-4721.

Ayanna 💜
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Name of Parent/Guardian:
Name & Age of Child (participant):
Phone Number of Parent:
Email of Parent:
Who has permission to drop off/pick up your child? Please include relationship & phone number.
Emergency Contact, Phone Number & Relationship:
Does your child have any allergies, chronic illnesses or medical conditions? Please list:
Does your child have any special needs (mental illness diagnosis, IEP/learning needs, etc)? Please list:
Do you have any past or current concerns about your child's social, emotional or behavioral needs? List them here:
What would you like your child to focus on especially during the "summer experience"?
Please read this consent. You will sign it during drop-off (9 am) or pick-up (3 pm) on Thursday July 21st.
Informed Consent, Media Release and Acknowledgement:

I hereby give my approval for my child’s participation in any and all activities prepared by True Love Movement during the selected "summer experience". In exchange for the acceptance of said child’s candidacy by True Love Movement., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless True Love Movement and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected "summer experience" sessions.

In case of injury to said child, I hereby waive all claims against True Love Movement including all instructors and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Medical Release and Authorization

As Parent and/or Guardian of your minor child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to True Love Movement and its affiliates including instructors and guests to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the "summer experience" sessions.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Media Release

Please be advised that during True Love Movement's "summer experience" your child may be videoed, photographed or interviewed.  With your consent, the video, photographs and/or interviews may be used for True Love Movement's website or social media. Please check your preference here:

☐ My child's image can be utilized for True Love Movement's website and/or social media account(s).

☐ My child's image can not be utilized for True Love Movement's website and/or social media account(s).

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