Meeting Bright Minds Registration

Meeting Bright Minds Registration

Ages 6 to 12 - First Saturday of Each Month from 10 am to Noon - $45 (Family discount available!)
Child's Name
Last Name*
First Name*
Middle Name*
Gender*

MaleFemale
Child's Information
Address*
City*
State*
Zip*
Home Phone*

Area CodePhone Number
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Birth Date*

MonthDayYear
Current Grade Level*
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Work Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Email Confirmation
Parents Email (registration confirmation will be sent by email)*
Other Information
How did you hear about Meeting Bright Minds?
Health Information
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. If contact information has changed between registration and the day of Meeting Bright Minds, please notify Winslow Institute at (208) 370-5236 or email wanda@winslowinstitute.com

We believe you are the best judge of your family's health and we trust you to determine whether your child is healthy enough to attend and participate.

If your child is exhibiting symptoms of fever, breathing difficulites, intestinal distress, or general flu-like symptoms please call to cancel your registration. We will either refund your registration fee or apply it to the next month's Meeting Bright Minds event.

Once your child's mood, appetite, and activity are normal and s/he has been fever free for 24 hours without a fever reducer, we will be happy to have your child join us!
Is the child free from infectious disease or conditions?*

YesNo
All fileds are required below. If nothing applies, please put "NONE" in the box. Thank you.
Any physical, mental or other condition that would require special attention or medication while attending?*
List any allergies (ex: bees, peanuts, dairy)*
Be certain to enter your email address correctly on the registration form to receive confirmation.
Attendee Release
Attendee Release (List anyone, including parents, to whom your child can be released. Child will not be released to an adult not listed here.)*
I authorize Winslow Institute to use my child's picture, testimony, and video in any promotional material (web, print, or media).*

YesNo
Signature*

Clear
By hitting submit and typing my initials, I confirm that I am the parent or legal guardian of the above named attendee, and that I am over the age of 18.

In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named child by authorized personnel.

I understand that the above named child will only be released to the names listed above.

I understand that I am responsible for picking up my child ontime and an additional charge will be assessed if I am late.

I certify that my child has my permission to attend Meeting Bright Minds and participate in all activites. I am aware that if my child's behavior consistently disrupts the learning of other attendees, I will be notified.
Electronic signature, please initial*
You can either pay with credit card, debit card, or a PayPal account. Depending on your browser's security settings, you may need allow redirects and pop-ups from http://winslowinstitute.com in order to be taken to the payment window.

If you have any questions feel free to contact us at Winslow Institute (208) 370-5236 or email wanda@winslowinstitute.com
Payment Information

My Products*

Meeting Bright Minds Saturday 10/4/2025 from 10 am to 12 pm $45.00

Call to ask about the Family Discount for 2 or more children!

Enter coupon

Total $0.00

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Meeting Bright Minds Registration

Child's Name

Child's Information

Parent or Legal Guardian Information

Email Confirmation

Other Information

Health Information

Attendee Release

Payment Information