Child's Name

Child's Email Address

Medical Details

Emergency contact

Relationship to child

Emergency contact mobile

Is your child up to date with vaccinations?Yes

Is there any special medical information, such as allergies, that we should be aware of?

Family doctor

Family doctor phone

Child's Medicare number

Medical 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.Yes

Permissions - Activities and Media

By selecting "Yes" I hereby permit my child to participate in all Rite of Passage activities and excursions.Yes

I agree to be a part of a Spiritgrow RoP Updates WhatsApp groupYes

By 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.Yes

Waiver of Liability

By 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.Yes

Parent's name

Email Address

Date

Credit / Debit Card *

A one off $150 deposit is required to secure your Bar/Bat Mitzvah date in the Spiritgrow calendar

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