• SENSE-ational Summer

    SENSE-ational Summer

    June/July 2026

  • JOIN US FOR OUR 3rd ANNUAL SENSE-ATIONAL SUMMER GROUP!

    SENSE-ational Summer is designed to provide a safe, fun space to engage in sensory exploration and play-based developmental activities! Participants must be between the ages of 6mo and 5yrs old - additional details below.

  • **This form is for the 2yr-Kindergarten Groups ONLY** Please use the link below for the 1st - 5th grade forms

    https://pci.jotform.com/form/261426533780155
  • Does this participant have any allergies, chronic illness, or medical conditions that may impact their ability to participation in activities? If yes, please describe.
    • Add Additional Participants (siblings) 
    • Does this participant have any allergies, chronic illness, or medical conditions that may impact their ability to participation in activities? If yes, please describe.
    • Does this participant have any allergies, chronic illness, or medical conditions that may impact their ability to participation in activities? If yes, please describe.
    • Does this participant have any allergies, chronic illness, or medical conditions that may impact their ability to participation in activities? If yes, please describe.
    • Does this participant have any allergies, chronic illness, or medical conditions that may impact their ability to participation in activities? If yes, please describe.

  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Participation Waiver and Assumption of Risk


    Any use of MoonBeam Therapies facilities/equipment (also referred to as “Facilities”) and participation in programs (“Programs”) and activities comes with inherent risks.
    By completing this form I,   *   *   (Parent/Guardian), am acknowledging that I have read and agree to ALL of the following:
     
    ·     I voluntarily accept and assume full responsibility for these risks as well as any and all other risks of the use of Facilities and participation in Programs.
     
    ·     I agree that I have full knowledge of the nature and extent of all such risks and am not relying on all such risks being described in this document.
     
    ·     I agree that MoonBeam Therapies, it’s officers, directors, agents, employees, volunteers, insurers and representatives (“Releasees”) will not be liable for any personal injury, property damage/theft, disability, death, sickness, disease including COVID-19, or accident incurred by myself, my family members, dependents, or guests, including minors, however occurring including, but not limited to the negligence of Releasees.
     
    ·      I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, disability, death, sickness, or disease sustained from the use of Facilities and participation in Programs.
     
    ·     I further agree, on behalf of myself and any and all legal successors and proxies, to release and HEREBY DO RELEASE, WAIVE AND COVENANT NOT TO SUE Releasees from any causes of action, claims, suits, liabilities or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I and any and all legal successors and proxies may have, now or in the future, against Releasees on account of personal injury, property damage/theft, disability, death, sickness, diseases including COVID-19 or accident of any kind, arising out of or in any way related to the use of Facilities or participation in Programs, whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees.
     
    ·      I agree to INDEMNIFY AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, suits, liabilities or costs of any nature whatsoever, including claims of negligence, arising out of or in any way related to the use of Facilities and participation in Programs by myself, my family members, dependents or guests, including any minors.

    Informed Consent and Acknowledgement
    By completing this form I hereby give my approval for my child’s participation in any and all event activities prepared by MoonBeam Therapies PLLC. 

  • CHECKOUT

    PLEASE MAKE SURE THE "QUANTITY" MATCHES THE NUMBER OF PARTICIPANTS YOU HAVE ADDED TO THIS FORM TO ENSURE ACCURATE PRICING! ("Quantity" is "0" (zero) if checkbox is not selected)

  • REFUND POLICY:

     

    Registration fees are non-refundable unless event is cancelled by organizers. 

     

  • REGISTER NOW (PLEASE CHOOSE ALL DESIRED DATES)*

    prevnext( X )
        "Baby & Me" : 6mo - 1 yr *

        15 minute mini-session Music & Movement Take-home craft *Requires parent participation

        $12.00$12.00
        DATES Quantity
        JUNE 10TH
        JUNE 17TH
        JULY 15TH
        JULY 22ND

        Item subtotal:$0.00$0.00
          
        10:00 - 10:45 am (2yr - Kindergarten)

        45 minute small play group including: Fine Motor, Gross Motor, and Sensory-focused activities. Registration is $25.00 per participant. Sibling discount price $20.50 each. (Must be registered on the same sing up form for discount) 

        $25.00$25.00
        DATES Quantity Price
        JUNE 10TH $25.00$25.00
        JUNE 17TH $25.00$25.00
        JULY 15TH $25.00$25.00
        JULY 22ND $25.00$25.00

        Item subtotal:$0.00$0.00
          
        Total
        $0.00$0.00

        Credit Card

      • Confirmation

        BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

      • Date*
         / /
      • Should be Empty: