SISG - Registration Form
Event Timing: September 2018 - June 2019 - First Friday of each month. Our first social is on September 7 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 already attends a Spectrum Insights program or coaching
I would like to be interviewed. Please see the additional comment section at the bottom of this form.
You can skip the contact details if there are no current changes. If this is your first time attending, please fill out the following questions.
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 a non refundable payment of $220 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.
I understand and agree
Payment is for Sept 2018 till June 2019. $225 if paid before June 2nd 2018. After June 2nd $250. The socials run on the first Friday of each month starting in September 2018 till June 2019. Drop in's are by invitation only.
I am choosing to sign my child up for 10 months - $225
I was invited to drop in by the director - $25
I will pay Via:
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.
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