A LOVED HUMAN GIRLS CLUB SLU

Participant Information

Child's First & Name

Child's Birthday

Month

Day

Year

Child's School

Grade

Parent/Guardian Information

First & Last Name

Relationship to Participant

Number

Alternate Number

Emergency Contact Information

Medical Information

Does your child have any allergies? (Please list all allergies, including food, medication, etc.)

Does your child have any medical conditions or require any special accommodations? (Please specify.)

Consent For Participation

I, the undersigned parent/guardian, give permission for my child to participate in the "A LOVED HUMAN" program, including attending in-person meetups on Wednesdays and participating in any trips organized by the program. I understand that all activities will be supervised by program staff and volunteers.

I acknowledge that there are inherent risks associated with participation in any program activities, including travel to and from events, and I agree to release and hold harmless "A LOVED HUMAN", its staff, volunteers, and affiliates from any and all liability for any injury or illness that may occur while my child is participating in the program.

Signature

Consent For In-person Meetup

Do you consent to your child attending in-person meetups on Wednesdays?

Yes

Consent for Trips

Do you consent to your child participating in trips organized by "A LOVED HUMAN"?

Yes

Non-Responsibility Clause

A Loved Human is not responsible for the following:

Transportation: We are not responsible for any incidents or accidents that occur during travel to and from program activities unless travel is organized and supervised by the program.
Medical Emergencies: We are not responsible for any medical emergencies that arise from undisclosed medical conditions or allergies.
Behavioral Issues: We are not responsible for managing behavioral issues that arise from conduct not disclosed in the application form.
Loss or Damage: We are not responsible for any loss or damage to personal belongings brought to program activities.
Third-Party Services: We are not responsible for any issues arising from services provided by third parties during trips or events.

By signing below, I confirm that I have read and understood the information provided, and I agree to the terms outlined above.

Signature

Program Schedule:

In-person meetups with Emma are held every Wednesday from 4:00 PM to 6:00 PM.

Zoom meeting with Sunshine are held every other Monday from 5:00 PM to 6:00 PM

Trip dates and times will be communicated in advance.

Location for in person meetups will be informed by Emma

Contact Information: 725-2025

For any questions or concerns, please contact Program Coordinator : Emma

A LOVED HUMAN GIRLS CLUB SLU

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