Parent-Child Meditation and Buddhism Class

Name of the Child *

Date of Birth of the Child *

Gender of the Child *

Name of the Parent/Guardian *

Relationship with the Child *

Contact Phone
*

Contact Email
*

Home Address

Please check all that apply to describe the physical condition of the child *

None

Allergies

Asthma

Heart Disease

Diabetes

Seizures

Hospitalized/Surgery

Other:

Emergency Contact Name and Relationship with the Child *

Emergency Contact Phone *

What do you hope for your child to learn from this class?

Introduced by / Relationship

Please be mindful of, and adhere to, the following guidelines. This is to provide a safe and secure environment for everyone to enjoy the class and promote an ideal environment to practice. By checking boxes below, you are agreeing to follow these guidelines.

*

Yes, I agree to follow.

To provide and ensure a safe environment for all participants, parents/guardians are requested to keep child(ren) at home when they have fever, nausea, or other contagious diseases. If a child becomes ill while in class, parents/guardians will be requested to pick up their child (ren).

If there are any health conditions (such as illnesses and allergies) of which we should be aware, it is the legal obligation of the parent/guardian to disclose such information to us.

In the case of illness, accidents and injuries, which may result from the participant's voluntary participation in the classes, Buddha Jewel Monastery and its volunteers and staff are not responsible for any and all liability or damages. It is the duty of the parent/guardian to provide primary accident and medical insurance for the child.

Yes, I agree to follow.

To provide and ensure a safe environment for all participants, parents/guardians are requested to keep child(ren) at home when they have fever, nausea, or other contagious diseases. If a child becomes ill while in class, parents/guardians will be requested to pick up their child (ren).

If there are any health conditions (such as illnesses and allergies) of which we should be aware, it is the legal obligation of the parent/guardian to disclose such information to us.

In the case of illness, accidents and injuries, which may result from the participant's voluntary participation in the classes, Buddha Jewel Monastery and its volunteers and staff are not responsible for any and all liability or damages. It is the duty of the parent/guardian to provide primary accident and medical insurance for the child.

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