Mindfulness Challenge 2019 - Parental Consent Form

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Dear Parent,

In order for your child under 18 years of age to participate in Mindfulness Challenge 2019, you must complete this form.

Mindfulness Challenge 2019 will take place Saturday, November 9, 2019.

For more information, please go to www.MindfulnessChallenge.ca or email challenge@mindfulnessstudies.com.

Our Age Requirements

Child currently under 18: Requires parental consent & waiver

Age 6 - 12 on November 9, 2019: Child must be accompanied by a parent

Under 6 on November 9, 2019: We are sorry but you must be at least 6 years old to participate.

Parent First Name *

Parent Last Name *

Parent's Email *

Parent's Phone *

Parent's Address *

Parent's City *

Child Participant First Name *

Child Participant Last Name *

Child Participant Date of Birth *

Location at which Child Participating *

Toronto

Ottawa

Oshawa

Kitchener

Other:

I hereby confirm that I am the parent or legal guardian of the above-named child *

Yes

I hereby confirm that my child will be at least 6 years of age on November 9, 2019 and, if under 13 years of age at that time, will be accompanied by a parent. *

Yes, my child will be at least 13 years of age on Nov 9, 2019

Yes, my child will be between 6 - 12 years of age on Nov 9, 2019 and will be accompanied by a parent

No, my chid will be less than 6 years of age on Nov 9, 2019.

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