Alite Mind Children’s Class Enrolment Form

Firstly, I would like to welcome everyone to Alite Mind - Meditation and Mindfulness. Could you please fill in the following class enrolment form for your child. This information is strictly confidential but is critically important for me to understand so I can best support and facilitate all meditation practices.

Please answer all items, so I can best support your child during these sessions. Thank you.


"*" indicates required fields

DD slash MM slash YYYY

About the child


Medical Information

If yes, please ensure he/she brings relevant medication with them to class and are able to administer to themselves.

Terms and Conditions

Alite Mind classes include movement, stretches, visualisation, breathing exercises, musical instruments, and children’s creative art techniques.
Do you consent to your child being involved? *

Parent’s Responsibilities

Alite Mind takes all reasonable care to ensure that its programmes are fun and safe. However, I understand that my child will be engaging in a moderate amount of physical activity that may involve some risk of injury. I acknowledge I have been advised to consult with my or my child’s physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect my child’s participation in the Alite Mind programme. In the event of emergency and in my absence agree to the Alite Mind facilitator contacting Emergency Services.*
I have read the Alite Mind child protection policy and in the event of my child not being collected I agree that Alite Mind can contact the social services duty for my child's protection.*
I confirm that I have fully disclosed to the Alite Mind facilitator any conditions (whether such conditions are physical, mental, behavioural) that my child has or may have before my child participates in the class.*
As far as is permitted under Local Law, I assume the above risks and accept responsibility for any injury sustained by my child. I further discharge and hold harmless Alite Mind (or its owners and other personnel) from any liability: arising from any injury to my child or other persons or property caused by my child’s participation. If that injury is caused either by my child’s fault, or by a third party unconnected with Alite Mind provision of services; or by events which Alite Mind, its owners, could not have foreseen or prevented even if they had taken reasonable care.*

Refund classes

Bookings and prepayment are required to hold your child’s place in the class. I understand and agree that I will not receive any refund or credit for missed classes where there has been no notification and resulted in failure to attend, but if cancellation of a class is due to failure on the part of Alite Mind I will be entitled to a reasonable refund of the charge for that class or a transfer of monies to the following class. Meditation classes may be cancelled if insufficient numbers, with referrals of any monies to the next class or if preferred a full refund. All possible care will be taken not to inconvenience any client. After 2 classes it may be apparent to the Alite Mind Coach that classes are not appropriate for a child at this stage. In this instance we will request that the child is removed from the class and the balance will be refunded.*

Thank you so much for your interest and involvement with these meditation sessions. I appreciate you completing this form. Should you ever have any questions, please feel free to contact me.


Warm Regards,
Natalie Michels
Counsellor, specialist Mindfulness and Meditation practitioner
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