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 has been interviewed by the director
My Child attends other Spectrum Insights Events
Parents Name(s) Please include phone number and email
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, my child may be photographed
No, my child may not be photographed
I understand that a non refundable payment of $250 guarantees my child a spot at the social group. We will not be reimbursing for missed days. Should there be a scheduling error on our part where a monthly social is cancelled and not rescheduled later in the month, we will reimburse the cost of the night missed.
Yes I understand and agree to the above
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
There are two options for registration: A full time spot from September 2018 to June 2019, $250. Drop in availability at $25/social.
I am registering for a full time spot
I am registering my child for drop in availability at $25 an event
I will pay Via:
Cheque to: John Anderson 316 Robillard Pvt Ottawa ON K1T2V8
Electronic Fund Transfer to:
By typing my name below, I confirm that I have read and understood the Registration Form. I also confirm that the information I have provided on this form is true, correct, and complete.
Send me a copy of my responses.
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