July 2026 Connect & Grow Registration

July 2026 Connect & Grow Registration

Connect and Grow is a program that strengthens family connection through movement, mindfulness, and social emotional wellness with simple daily activities. Each class will be roughly 45 minutes and will happen rain or shine, so please dress for the weather and for you and your child to be able to comfortably move around. If more than one child will be attending, please fill out a form for each child. Registration is limited to 25 children.
Summer Session Dates

1st Wednesdays: June 3rd, July 1st, Aug 5th

*This registration is for our July session on July 1st. Please register separately for August if you plan to attend both.

Time: 10:00 am

Location: Bush Park (meet at lower Lefelle parking lot - see map below)
Email
example@example.com
Parent or Guardian's Name

First NameLast Name
Parent or Guardian's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name & Age of Participating Child
Is this your first time participating in a Connect & Grow Session?

Other
How did you hear about this program?
Liability Waiver

To the best of my knowledge, I and/or my child(ren) are fully able to safely participate in the volunteer and/or educational activities in which I have signed up to participate. I will communicate any special needs in writing on this form before my or my child(ren)’s first activity, class or volunteer shift. I am fully aware of any risks and hazards connected with volunteering and/or participating in any Early Learning Hub activity and I take sole responsibility for maintaining my health and well-being and that of my child(ren).I voluntarily assume full responsibility for any risks or loss, property damage, or personal injury, including death that may be sustained by me or my child(ren), or loss or damage to property owned by me, as a result of volunteering or participating in an Early Learning Hub activity. I hereby release, waive, discharge, and covenant not to sue, the Marion & Polk Early Learning Hub, Lisa Harnisch, and/or any and all associates, family members, agents, and employees of the aforementioned organizations and individuals (here in after referred to as “Releases”) from any and all liability claims, demands, actions and causes of actions whatsoever arising out of correlated to any loss, damage, or injury, including death, that may be sustained by me and/or my child(ren), or to any property belonging to me, while volunteering or participating in an Early Learning Hub activity. It is my expressed intent that this Waiver shall bind the members of my family and spouse and/or domestic partner, if I am alive, and my heirs, assigns and personal representative(s), if I am deceased, and shall be deemed as a release, waive, discharge, and covenant not to sue the above named Releases. I hereby further agree that this Waiver of Liability shall be construed in accordance with and governed by the laws of the State of Oregon. In signing this release, I acknowledge and represent that I have read this Waiver of Liability, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I execute this release for full, adequate and complete consideration fully intending to be bound by same.
Signature
Do you give permission for photos/videos to be taken of your child during the Connect & Grow Sessions? Content may be used on social media, future Connect & Grow flyers or other promotional content for the class.
Signature - This agreement is legally binding. By signing my name below, I acknowledge this electronic signature is valid.
Please describe any special needs, accommodations, allergies and/or sensitivities that our team should be aware of. If none, write "NA".
We look forward to seeing you at our next Connect & Grow Session!

Meet at the Lower Leffelle Parking Lot at Bush Park at 10:00 a.m. Navigation from Google Maps is not reliable. Starting from the Upper Leffelle Parking Lot at 651 Leffelle St SE, Salem, OR 97302, drive east on Leffelle St. SE. Turn right on on Winter St. SE. Turn left on Summer St. SE. Turn right on Leffelle St. SE and go to the end to park in the parking lot. See Map below.
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July 2026 Connect & Grow Registration

Liability Waiver

We look forward to seeing you at our next Connect & Grow Session!