MINOR INFORMED CONSENT

 
 

I, (parent/guardian*) hereby give permission to my child (name*) to attend and participate in the Mindfulness For Kids on Thursday, August 23, 2018.  

The educator, Chelsea Karpoy will provide an educational space for your child for self-reflection and mindfulness techniques.  Chelsea is a mental health community educator, not a clinician.  I understand that this workshop is not a therapeutic, counseling, or psychotherapy setting.   

Except in the case of gross negligence or malpractice, I or my representatives agree and hold harmless Amy Lee Czadzeck of To the Moon and Back from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with this workshop.

Your child’s decision to share their experience within the group will be voluntary and rules for listening and mutual respect will be asked to be followed.

I (parent/guardian*) hereby give permission for my child to attend.

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