Around the World

An engaging, hands-on program designed to spark curiosity and global awareness.

Start date: 16-02-2026

Schedule: Mondays - 10:30 am to 12:00 pm

Location: Hillview Intercultural Community Centre

xx Name of Student*

First NameLast Name

Participant Name*

First & Last Name

Student Date of Birth*

Date

Home Address*

Street Address

Street Address Line 2

Postal / Zip Code

xx School (if applicable)

xx Language Spoken at Home

xx Grade Level

xx Special Needs or Accommodations*

Which areas does your child enjoy or show interest in? (tick all that apply)

Special Needs or Accommodations*

If Yes, Please mention details in the "Additional Comments or Notes" field.

Additional Comments or Notes

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Name*

First & Last Name

Relationship to Student*

MotherFatherStep-ParentGuardian

Parents' Address

Street Address

Street Address Line 2

Postal / Zip Code

Mobile Number*

Email*

example@example.com

The parent/guardian will be contacted first in an emergency?*

YesNo

Phone Number*

Name of Emergency Contact 1*

First & Last Name

xx Emergency Contact Name*

First NameLast Name

xx Relationship to Student*

ParentGuardianRelativeOther

Mobile Number*

xxPhone Number*

Please enter a valid phone number.

Email*

example@example.com

Name of Emergency Contact 2*

First & Last Name

xx Emergency Contact Name*

First NameLast Name

xx Relationship to Student*

ParentGuardianRelativeOther

Mobile Number*

xx Phone Number*

Please enter a valid phone number.

Email*

example@example.com

xx Please list any relevant medical conditions, allergies, or medications if any.

Any medical conditions/allergies?*

YesNo

If Yes, please specify:

Consents and Authorizations:

Please tick the boxes below*

I agree to grant my consent to manage emergencies if no contact is establishedI will keep my sick child home and notify the programI will supply any necessary medicationI consent to pay any medical charges or expenses that could be incurred in case of emergency.

Photography and Videography Consent

I consent to the photography and/or videography of my child. I understand that any photos or videos will be used solely for marketing purposes. If you do not respond to this consent request, your consent to photography and/or videography of your child will be assumed.*

Opt In: I consent to photography and/or videography of my child for marketing purposes.Opt Out: I do NOT consent to photography and/or videography of my child.

Consent for Receiving Marketing Communications

Please indicate your preference for receiving marketing materials from Flourishing Minds Academy.*

Email: I consent to receive marketing emails.SMS/Text Message: I consent to receive marketing SMS/text messages.Phone Call: I consent to receive marketing phone calls.No Contact: I do NOT wish to receive any marketing communications.

You may update or withdraw your preferences at any time by contacting us on our email flourishing.minds.academy@gmail.com with "Unsubscribe" in the subject. Your privacy is important, and your contact details will be handled confidentially in accordance with our privacy policy.

Parent/Guardian Signature (if student is a minor)*

By submitting this form, I authorize Flourishing Minds Academy to use the information provided for educational and administrative purposes. I confirm that the information is accurate to the best of my knowledge. I understand that typing my name below constitutes a valid electronic consent.*

I confirm that I am the parent or legal guardian of the child and consent to their participation in this program.

Parent/Guardian Full Name *

Type your name to confirm

Date Signed*

DD-MM-YYYY

Date Signed*

Date

Registration Form

Participant Information

Parent/Guardian Information:

Emergency Details 1

Emergency Details 2

Additional Medical Information:

Payment Methods