MOTHERSHIP WELLNESS

Adelina, strong like mommy

This page lets Adelina's mom (aka THE BADDEST) pay for the 1st and 3rd weeks of the Junior Baddie series at a half rate of $162.50.

A NOTE FROM ASHLEY

Consider having me and/or yourself encourage David and Yvette to have Adelina come the other weeks as well, so she can fuse team-manship with the other girls. This isn't necessary, just a thought.

CHILD INFORMATION

Child's Name

Age *

Allergies / Dietary Restrictions

Therapeutic Considerations

GUARDIAN INFORMATION

Guardian Name *

Guardian Email *

Guardian Phone *

EMERGENCY CONTACT

Emergency Contact Name *

Emergency Contact Phone *

WAIVER & CONSENT

JUNIOR BADDIE - GUARDIAN CONSENT & WAIVER

1. Program Participation: I grant permission for my child to participate in the Junior Baddie program (girls ages 8-12), which includes team building, breathwork, yoga, strength training, nutrition activities, and occasional field trips or track sessions.

2. Assumption of Risk: I understand physical activity carries inherent risk of injury. I confirm my child is in good health and able to participate.

3. Emergency Medical Authorization: I authorize Ashley Damaj and program staff to seek and authorize emergency medical treatment for my child if I cannot be reached.

4. Transportation Authorization: I authorize Ashley Damaj to transport my child by vehicle to and from class locations, including field trips and track sessions.

5. Release of Liability: I release and hold harmless Ashley Damaj and Mothership Wellness from any claims arising from my child's participation, except in cases of gross negligence or willful misconduct.

6. Information Accuracy: I confirm all information provided (allergies, therapeutic considerations, emergency contacts) is accurate and complete.

I authorize emergency medical treatment for my child.I authorize Ashley to transport my child by vehicle.I have read and agree to the full waiver above.

Guardian Signature (type full name) *

Weeks 1 & 3 (Half Rate)$162.50