Blomst Community
Please fill out this form before entering the Blomst Community space.
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Name of Parent *
Name of Child *
Birth date of Child *
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Parent phone number: *
Parent email address: *
Address  *
Name + relationship to child/children, of adult attending the Blomst Community space: *
Please tell us a bit about your family and/or anything else you want us to know (we can't wait to meet you): *
By attending the Blomst Community space, I agree that:

- I am responsible for myself, the child/children attending with me and our belongings at all times. 

- I will not use any electronics while attending the Blomst Community space. I acknowledge that eye contact is essential for healthy development in humans and I will ensure that my family meets and interacts with all children and adults in a loving and respectful way at all times.

- Our family will treat the Blomst Community space and the other people attending the space, with love and kindness at all times.

- I acknowledge that this space is created with trust + love for families like ours, and I agree that our family will leave the space clean and neat. 

- I promise to join in and sing to the best of my abilities during the song circle!! I acknowledge that music is healthy and stimulating for my child/children and all the other children enjoying the adult voices joined in song <3

- Our family is entering the Blomst Community space at our own risk and will not hold the Blomst Community, the founder + volunteers of the Blomst Community or the Brave & Kind Bookshop reliable for any injuries or damages at any point.

- Our family will respect and adhere to the asks of the Blomst Community space volunteers at all times. 

- We will never enter the Blomst Community space if we have had any signs of illness (fever, vomiting or rashes) within the past 48 hours, or if we have any suspicion that any member of our family might be ill.

- We understand that under Georgia law, there is no liability for an injury or death of an individual entering these premises if such injury or death results from the inherent risks of contracting COVID-19. We are assuming this risk by entering these premises.

I have read and understood this disclaimer:
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