Collective Souls, Inc.                                              Nurturing A Rose Girls Workshop                            
This is a special enrichment workshop for girls 8-13 years of age learning how to to empower "SELF" by developing the mind and body with educational, physical and social activities.  

We will have group activities along with age appropriate breakout sessions, 8-10 years & 11-13 years.
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Child's Name *
New or Returning Youth *
Child's Age *
Child's Birthday *
Entering Grade for Fall 2023 *
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Dietary restrictions
What breakfast and lunch item would your child prefer? (breakfast items served 9:45-10am & lunch items served 12pm) Beverages will be provided. *
Do you have any comments or concerns about your child that you would like to share with the organization?   *

Please read before submitting*

In consideration of my child’s participation, I agree to indemnify Collective Souls Incorporated, Associates, Facility Owners and Volunteers from any claims or lawsuits brought against Collective Souls Incorporated, by myself, my child, or others, that arises out of any behavior or injuries by my child during the program times. Participant and participant’s parent or guardian, (if participant is a minor) agree that this agreement and release of liability is a contract that when submitted by the participant’s parent or guardian involved will be legally binding to all parties and shall be enforced and interpreted under the laws of the state of Missouri. I also understand that I am allowing my child to participate in this program under my own discretion and I am solely responsible for any medical attention or medical equipment for my child due to any injuries. I hereby grant permission to Collective Souls, Inc., representatives to take and use photos, images including testimonies of my child for use in news release and/or educational materials, marketing, or web site. I authorize the use of these images without compensation to me or my child. 

Parents, please note if your child is uncooperative, cause harm to self or others and disrespectful to program leaders or peers, they will be removed from the program.

Parent/Guardian please type your name below showing that you have read and agree to the above information.

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