Join us - Smiling Light

Families in the now program

$480

10 weeks

Rouse Hill

Tuesdays (kids 8 to 10 y/o) or wednesdays (pre-teens 11 to 14 y/o), 5:00 to 7:00 pm, after school.

To register for the program "Families in the Now", please fill out the following form:

Participant's Information:

Participant's First Name *

Participant's Last Name *

Email Address *This is where we'll get in touch

Street Address *

Apartment, suite, etc

Parent / Guardian Information:

Parent / Guardian Name *

Phone number *

Parent / Guardian Name 2 *

Phone number 2

Who is picking up the child?(Optional)

About the child:

Does your child have any known emotional or behavioural considerations? *YesNo

Please state in brief what and discuss this with your Smiling Light Coach.

Is your child willing to do Families in the Now program?YesNo

Medical Information:

Health Insurance Provider(Optional)

Does your child have any medical conditions or special needs that the Coach needs to be aware of? *YesNo*If yes Please ensure he/she brings relevant medication with them to class and are able to administer to themselves.

Please list the most relevant medical conditions or special needs that your child might have? *

Does your child have any allergic conditions? *YesNo

Please list all allergies your child has *

Does your child use an Epi-Pen? *YesNo*If yes please ensure he/she brings the relevant device, and the Coach will be able to administer it if necessary.

Terms and Conditions:

Smiling Light classes include movement, stretches, visualisation and breathing exercises. Do you consent to your child being involved? *YesNo

I give permission to Smiling Light to photograph and videotape my child during program activities.

I agree

Parent’s Responsibilities: Smiling Light takes all reasonable care to ensure that its programmes are fun and safe. However, I understand that my child will be engaging in a moderate amount of physical activity that may involve some risk of injury. I acknowledge I have been advised to consult with my or my child’s physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect my child’s participation in the Smiling Light programme. In the event of emergency and in my absence agree to the Smiling Light Coach contacting Emergency Services.

I agree

I have read the Smiling Light child protection policy and in the event of my child not being collected I agree that Smiling Light Coach can contact the social services duty for my child's protection. Please note we charge $5 per 15 minutes if you are late picking up your child.

I agree

I confirm that I have fully disclosed to the Smiling Light coach any conditions (whether such conditions are physical, mental, behavioural) that my child has or may have before my child participates in the class.

I agree

As far as is permitted under Local Law, I assume the above risks and accept responsibility for any injury sustained by my child. I further discharge and hold harmless Smiling Light Coach (or its owners and other personnel) from any liability: arising from any injury to my child or other persons or property caused by my child’s participation in the Smiling Light programme if that injury is caused either by my child’s fault, or by a third party unconnected with Smiling Light provision of services; or by events which Smiling Light, its owners, officers or personnel including its coaches and its suppliers could not have foreseen or prevented even if they had taken reasonable care.

I agree

Refund Classes: Prorated refunds will be given if cancellation is made in writing before the second attended class of the series. I understand and agree that I will not receive any refund or credit for missed classes, but if cancellation of a class is due to failure on the part of Smiling Light I will be entitled to a reasonable refund of the charge for that class. After 2 classes it may be apparent to the Smiling Light Coach that classes are not appropriate for a child at this stage. In this instance we will request that the child is removed from the class and the balance will be refunded.

I agree

Parent / Guardian NameSignature

Date *

Date the request is sent.

Payment options:

Please send your proof of payment to the following email: [email protected].

1. Pay ID:

Phone #

0415 672 119

2. Bank account:

Please, transfer your payment to the following bank account:

Acct: 1042-0472 BSB: 062-192

COMMONWEALTH BANK.

3. Online payment:

Make your payment online through stripe (We don't store any credit card data in our site).

Name *

Email Address *

Phone *

Street Address *

Suburb *

State *

Post Code *

Credit / Debit Card *