My Behaviour Matters Registration Form

DISCLAIMER 

My Behaviour Matters workshops provide psychoeducational services and do not offer individual counselling, psychotherapy, or therapeutic interventions.   

Completion of this form does not guarantee registration in the workshop(s). Payment in full is required to secure your child(ren)’s spot.   

Refunds, excluding the administrative fee, will be issued only if My Behaviour Matters is notified of cancellation within 2 weeks of the initial registration and full payment. 

My Behaviour Matters will not provide refunds for missed sessions. 

A workshop may be cancelled if participant numbers do not meet the minimum requirements. In such an event, you can either receive a full refund, minus the administrative fee, or secure your place for one of the next available workshops. 

PRIVACY POLICY 

At My Behaviour Matters, we understand the importance of privacy and take the protection of information seriously. This Privacy Policy outlines the types of personal information we collect, how we use it, and the steps we take to protect it. 

Types of Information Collected 

We collect the following information from our participants: 

1. Contact information, such as name, email address, home address and telephone number. 

2. Demographic information, such as age and current educational environment. 

3. Information related to billing and payments, such as email addresses. 

Purposes for Information Collection 

The information we collect is used for the following purposes:  

1. To provide psychoeducational services to participants. 

2. To process payment for services rendered. 

3. To improve our services and the overall experience of our clients. 

Protection of Information 

My Behaviour Matters will not sell or share our participants personal information with third parties, except as required by law or in the following circumstances: 

1. With the client’s prior written consent. 

2. To protect the safety of our participants or others. 

3. To comply with a legal request or court order. 

Contact 

If you have any questions or concerns about this Privacy Policy, please contact us at mybehaviourmatters@gmail.com. 

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Date *
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Child's Name *
Child's Date of Birth *
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Child's Age *
Child's Gender *
Which Educational Environment Best Describes Your Child's Current Situation?
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Home Address *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian Email Address *
Please Specify Your Relationship with the Child *
Please Use This Space to Share Any Additional Information or Comments You'd Like Us to Know
Please Select the Workshop(s) You’d Like Your Child to Attend
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Required
Do you prefer to attend in person (available only to residents of Simcoe County and District Municipality of Muskoka) or online (available to everyone) *
Required
Where Did You Hear About The Workshops?
Consent: I provide consent for my child to attend the workshops listed above.  Please Type Your Name: *
I give permission for my child(ren) to be photographed for the purposes of advertising future My Behaviour Matters workshops.
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I permit My Behaviour Matters to contact me regarding future workshops.
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PARENT/GUARDIAN WAIVER FOR MINOR PARTICIPANT(S)

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

IN CONSIDERATION for allowing my minor child(ren) to participate in the activities associated with My Behaviour Matters workshops, I hereby warrant and agree:

· I am the parent/guardian having full responsibility for decisions regarding my minor child(ren).

· I believe that my minor child(ren) is/are physically and emotionally fit to participate in My Behaviour Matters sessions.

· I will ensure that my minor child(ren) understand(s) and adhere(s) to all applicable rules for participation. I acknowledge that the sole responsibility for their personal safety remains with me. I will assist my child(ren) with any emotional or behavioral needs during the sessions, and if necessary, will promptly remove my child(ren) to address these needs outside of the workshop area.

I UNDERSTAND AND AGREE ON BEHALF OF MY MINOR CHILD(REN) THAT BY SIGNING THIS DOCUMENT I:

· Acknowledge that My Behaviour Matters has implemented adequate safety measures to ensure the well-being of all participants, including children and parents/guardians. I willingly accept any potential risks associated with my child(ren)'s participation in these workshops.

· Waive all present and future claims against My Behaviour Matters, thereby releasing them from any liability for potential loss, damage, injury, or expenses incurred by my minor child(ren) or myself.

· Acknowledge and agree to indemnify My Behaviour Matters and release them from any expenses related to litigation, legal fees, liability, damages, awards, or costs, regardless of their nature or type.


Please type your name below to sign; physical signature will be obtained at workshop:

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