Child's NameChild's Email AddressMedical DetailsEmergency contactRelationship to childEmergency contact mobileIs your child up to date with vaccinations?YesIs there any special medical information, such as allergies, that we should be aware of?Family doctorFamily doctor phoneChild's Medicare numberMedical release: By selecting "Yes" I hereby authorize Spiritgrow staff to obtain any medical care necessary for my child. I understand that in the case of an emergency or any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness.YesPermissions - Activities and MediaBy selecting "Yes" I hereby permit my child to participate in all Rite of Passage activities and excursions.YesI agree to be a part of a Spiritgrow RoP Updates WhatsApp groupYesBy selecting "Yes" I hereby grant permission to use photos or videos of your child at Spiritgrow’s discretion and give full permission to Spiritgrow to use photographs and videos of your child for PR purposes.YesWaiver of LiabilityBy selecting "Yes", I hereby unconditionally release Spiritgrow Centre and Library Assoc. Inc., and any of their officers, directors, executives, employees, agents, volunteers and anyone working under, through or in connection with any of them with respect to any incident, claim, occurrence, loss, injury, or damage whether known or unknown, present or future, foreseeable or not, that could or may arise out of such participation in any and all programs and activities, including provided travel to and from, in which I participate at the Spiritgrow Centre and Library. I, the undersigned, have read and understand the above statements and I agree to abide by all the rules and guidelines of Spiritgrow.YesParent's nameEmail AddressDateCredit / Debit Card *A one off $150 deposit is required to secure your Bar/Bat Mitzvah date in the Spiritgrow calendarSubmitPlease do not fill in this field.
