Payment for 1 Child | Mindful Kiddo - Mindfulness, Resilience and Wellbeing

Your First Name (Parent)
Your Last Name (Parent)
Child's First Name*
Please enter the name of your child here. If you are enrolling more than one child you will have the option to add more children in the next step.
Child's Last Name
Child 1 Room Name/Number
Please choose the class from the dropdown list your child you wish your child to attend.*
Please inform us of any health issues, disabilities or special talents of your child.
Emergency Contact Name
Emergency Contact Number
Email*
Consent*
I understand that Mindfulness Class include physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As in the case with any physical activity, the risk of injury, event serious or disabling, is always present and cannot be entirely eliminated. Mindfulness is not a substitute for medical attention, examination, diagnosis or treatment. Physical movement is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether my child is fit to practice mindful movement. I also understand that supportive and encouraging touch, massage, and partner and group interaction is an integral part of this class. I hereby agree to irrevocably release and waive any claims that my child/children now or hereafter, may have against Mindful Kiddo instructor.*
I agree for my child to participate in physical activity
I give permission to take photos and/or videos of my child during class activities. They will be used only to produce weekly online updates. Seesaw is a secure, digital portfolio that gives you real-time glimpses into your child's class experience and allows parents-teacher communication.*
- YES
- NO
Consent*
I agree to the Mindful Kiddo Terms & Conditions - View Terms & Conditions Here
I agree to the Mindful Kiddo Terms & Conditions
Do you wish to enrol another child?*
- YES - I want to enrol another child
- NO - Go straight to payment section
Child 2 First Name
Child 2 Last Name
Child 2 Room Name/Number
Please choose the class from the dropdown list your child you wish your child to attend.*
Please inform us of any health issues, disabilities or special talents of your child.
Consent*
I understand that Mindfulness Class include physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As in the case with any physical activity, the risk of injury, event serious or disabling, is always present and cannot be entirely eliminated. Mindfulness is not a substitute for medical attention, examination, diagnosis or treatment. Physical movement is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether my child is fit to practice mindful movement. I also understand that supportive and encouraging touch, massage, and partner and group interaction is an integral part of this class. I hereby agree to irrevocably release and waive any claims that my child/children now or hereafter, may have against Mindful Kiddo instructor.*
I agree for my child to participate in physical activity
Consent*
I agree to the Mindful Kiddo Terms & Conditions - View Terms & Conditions Here
I agree to the Mindful Kiddo Terms & Conditions
I give permission to take photos and/or videos of my child during class activities. They will be used only to produce weekly online updates. Seesaw is a secure, digital portfolio that gives you real-time glimpses into your child's class experience and allows parents-teacher communication.*
- YES
- NO

Enrolment Form - Mindful Kiddo