Blooming Roses Registration & Waiver

Blooming Roses Registration

Program dates: August 7th to May 21 • Fridays • 10:00AM-2:00PM (closed for major holidays)
About the Program
Blooming Roses is a girls' socio-emotional enrichment program for ages 9–13 that combines friendship, confidence-building, leadership, creativity, and real-world learning in a supportive small-group environment.

Girls participate in guided discussions, creative projects, leadership activities, community experiences, and hands-on enrichment designed to strengthen emotional intelligence, communication, resilience, and healthy relationships.

On First Fridays, participants enjoy lunch at a local downtown restaurant, provided by Three Pillars Learning Group, as an opportunity to practice social skills, conversation, and community engagement. Parents are responsible for informing staff of any food allergies or dietary restrictions.

Throughout the year, Blooming Roses also features special guest instructors offering enrichment experiences such as: art, crochet, coding, and music. Guest instructors, schedules, activities, and community experiences are subject to change based on availability. Equivalent opportunities may be substituted when necessary.

Blooming Roses explores topics such as friendship, communication, self-esteem, emotions, leadership, goal setting, digital citizenship, and healthy relationships in age-appropriate ways. The program is educational in nature and is not counseling, therapy, or mental health treatment.
About the Instructor
Blooming Roses is facilitated by Michelle Gonzalez, founder of Three Pillars Learning Group. Michelle is a certified educator with experience supporting neurodiverse learners, executive functioning, and social-emotional development. She is passionate about creating safe, welcoming spaces where preteens and teens build confidence, meaningful friendships, independence, and real-world skills.

The program's social-emotional curriculum is enhanced through twice-monthly virtual sessions led by Dr. Meridith Gould of Empower Me. Dr. Gould provides age-appropriate instruction focused on emotional wellness, communication, self-awareness, healthy relationships, and personal growth.
Parent/Guardian Information
Parent/Guardian Name

First NameMiddle NameLast Name
Parent/Guardian Relationship
Phone
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Student Information
Student Name

First NameMiddle NameLast Name
Preferred Name
Student Address
Email
example@example.com
Date of Birth

MonthDayYear
Date
Grade or Program Level
T-Shirt Size
Emergency & Medical Information
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
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Authorized Pickups

Other
Authorized Pickup Name

First NameLast Name
Authorized Pickup Phone Number
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Allergies
Medical Conditions
Current Medications
Behavioral or Learning Needs
Primary Care Physician
Physician Phone
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Anything else we should know?
Permissions & Waivers
Photo & Media Release
Sunscreen Permission
Insect Repellent Permission
May the student have nut-free snacks and water from the program?
Assumption of Risk & Liability Waiver

I understand that participation in Blooming Roses may include walking, outdoor activities, community outings, leadership activities, creative projects, games, recreational activities, guest presentations, restaurant visits, and other educational and socio-emotional enrichment experiences that involve physical activity, outdoor conditions, uneven terrain, weather exposure, transportation by foot, and other inherent risks that cannot be completely eliminated.

I voluntarily permit my child to participate in these activities and acknowledge that no activity is entirely risk-free. I agree that my child will follow all program rules and staff instructions while participating.

To the fullest extent permitted by applicable law, I voluntarily assume all ordinary risks associated with participation and release, waive, and hold harmless Three Pillars Learning Group, LLC, Michelle Gonzalez, its employees, volunteers, contractors, host facilities, guest instructors, and partnering organizations from any claims, demands, causes of action, damages, losses, injuries, illnesses, or expenses arising out of or related to my child's participation in Blooming Roses, except to the extent caused by gross negligence, reckless misconduct, or intentional wrongdoing.

I understand that Three Pillars Learning Group, LLC and Michelle Gonzalez are not responsible for accidents, injuries, illnesses, allergic reactions, lost, stolen, or damaged personal property, or other incidents that may occur as a result of the ordinary risks of participation in program activities.

I have carefully read this waiver, understand its contents, and voluntarily agree to its terms.
Assumption of Risk & Liability Waiver Initials

Parent/guardian initials.
Behavior & Safety

Students must be respectful, follow staff directions, stay with the group, and help keep everyone safe. Unsafe or disruptive behavior may result in dismissal.
Social-Emotional Learning & Group Expectations

Respect & ConfidentialityBlooming Roses encourages open conversation and personal growth. Participants are expected to treat one another with kindness, respect differing opinions, and help create a safe environment for everyone.While girls are encouraged to respect one another's privacy, Three Pillars Learning Group cannot guarantee confidentiality among participants. Parents are encouraged to discuss appropriate sharing and respectful communication with their child before participating.
Parent Communication

Parents will receive periodic updates about program themes and activities. To preserve trust within the group, specific personal information shared by participants will generally remain confidential unless there is a concern involving safety, abuse, self-harm, harm to others, or another situation requiring parental notification or mandatory reporting.
Illness Policy

Stay home if there is a fever, vomiting, diarrhea, or another contagious illness. Participants may return after being symptom-free for at least 24 hours.
Parent/Guardian Signature

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Student Signature

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Signature Date

MonthDayYear
Date
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Blooming Roses Registration

About the Program

About the Instructor

Parent/Guardian Information

Student Information

Emergency & Medical Information

Permissions & Waivers

Behavior & Safety

Social-Emotional Learning & Group Expectations

Parent Communication

Illness Policy