Mindfulness Challenge 2017 - Parental Consent Form
Dear Parent,

In order for your child under 18 years of age to participate in Mindfulness Challenge 2017, you must complete this form.

Mindfulness Challenge 2017 will take place Sunday, October 15. Orientation begins at 10:30 am and the main program will finish by 3:00 pm.

For more information, please go to www.MindfulnessChallenge.ca or email challenge@mindfulnessstudies.com.

Our Age Requirements
Child currently under 18: Requires parental consent & waiver

Age 10 - 12 on October 15, 2017: Child must be accompanied by a parent

Under 10 on October 15, 2017: We are sorry but you must be at least 10 years old to participate.

Parent First Name *
Your answer
Parent Last Name *
Your answer
Parent's Email *
Your answer
Parent's Phone *
Your answer
Parent's Address *
Your answer
Parent's City *
Your answer
Child Participant First Name *
Your answer
Child Participant Last Name *
Your answer
Child Participant Date of Birth *
Your answer
Location at which Child Participating *
I hereby confirm that I am the parent or legal guardian of the above-named child *
I hereby confirm that my child will be at least 10 years of age on October 15, 2017 and, if under 13 years of age at that time, will be accompanied by a parent. *
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