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HART IN HARMONY -
WELLBEING FOR CHILDREN
CONSENT FORM (1 CHILD)
Child's first name
*
Child's last name
*
Child's Date of Birth
*
Day
Month
Year
Medical Conditions, Additional Needs or Allergies which may impact participation
*
Parent/Guardian name
*
Phone
*
Email
*
Emergency Contact name
*
Emergency Contact Phone
*
What do you hope your child will gain from the session/program?
*
Do you consent to the use of essential oils (often organic) being diluted and sprayed/rolled onto skin?
*
Do you consent to Maranda offering hands on/physical guidance to your child throughout the session as appropriate - e.g. support with a certain yoga posture, a hug if in distress, placing a crystal onto the body during meditation?
*
Do you consent to photographs being taken during session for sharing to session/program group via email? Children are always asked for consent and their wishes respected.
*
Do you consent for photographs to be used for advertising and promotional purposes? This may include business social media pages, business website, flyers or school presentations for educational purposes.
*
Hart in Harmony - Wellbeing for Children takes all reasonable care to ensure that its sessions are enjoyable and safe; however, I understand and acknowledge that my child will be engaging in physical activity that may involve some risk of injury.
*
In the event of an emergency and in my absence, I agree to Maranda Hart of Hart in Harmony - Wellbeing for Children contacting emergency services.
*
I confirm that instructions given throughout class are intended only as guidance. It is therefore the responsibility of my child, during the session to listen carefully and practice the movements to their limitations to ensure no personal injury occurs.
*
I confirm that I have fully disclosed to Maranda Hart any, and all conditions that my child has or may have prior to my child participating in the session or program that may impact their safety, participation or response.
*
Signature
*
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Date
*
Day
Month
Year
Submit
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