After School Program Enrollment Form

Children's Mindfulness and Meditation Afterschool Program

2024-2025
At Conscious Development, our Children's Meditation Group is all about making mindfulness fun and accessible for young minds, specifically designed for children ages 5-10. We have thoughtfully crafted our program to include guided meditation and visualization, mindful listening, breathing exercises, creative expression, intentional movement, all in a way that's super engaging and kid-friendly.

Meditation has many benefits for children, like improving focus, self-awareness, and helping them find a sense of calm. It's not just something we believe in; research backs it up too! Studies have shown that mindfulness can boost attention, social skills, behavior, and even academic performance in school-aged kids.

We are passionate about introducing meditation to children early on because we know it helps them develop the tools they need to handle life's challenges, stress, and emotions. By bringing mindfulness into their lives, we are also helping to break long-standing cycles and build a healthier, more balanced future for them.

We have already teamed up with Spirituality Week and The Rubin Museum, and now we are thrilled to announce our new collaboration with Daya Yoga, launching the Daya Kids program! If you are a parent looking for guided meditation and visualization sessions for your child, we are here to support you every step of the way. We cannot wait to connect with you and share this transformative journey!
Parent's Name*

First NameLast Name
Parent's Phone Number*

Area CodePhone Number
Parent's Email*
Student's Name*

First NameLast Name
Grade in fall (2024-2025)*

JrKKindergartenGrade 1Grade 2Grade 3Grade 4Grade 5
Please note any known allergies:
Effective date for enrollment in After School Program*

MonthDayYear
Please note that our after school program begins 10/02/24
Please specify each person, including the name of parents, who has permission to pick up your child from the After School Program.
Authorized Person 1:*

First NameLast Name
Phone Number 1:*

Area CodePhone Number
Relationship*
Authorized Person 2:

First NameLast Name
Phone Number 2:

Area CodePhone Number
Relationship
Authorized Person 3:

First NameLast Name
Phone Number 3:

Area CodePhone Number
Relationship
Liability Waiver
At Conscious Development and Daya Yoga, the safety and well-being of all children are our top priorities. We are committed to providing a nurturing and secure environment and will do everything in our power to ensure that your child is safe during their time with us. However, we understand that accidents can sometimes happen despite our best efforts.

By signing below, I acknowledge that while Conscious Development and Daya Yoga will take every precaution to safeguard the children, they cannot guarantee that an accident will not occur. I, the undersigned, understand that Conscious Development and Daya Yoga are not liable for any accidents, injuries, or incidents that may take place during the Conscious Kids & Daya Kids Afterschool Program. I accept full responsibility for my child's participation in this program.
Parent's Name*

First NameLast Name
Signature*

Powered by Jotform SignClear
Should be Empty:

Children's Mindfulness and Meditation Afterschool Program

Liability Waiver