In Our Mother’s Garden Brunch

Bloom Upstate Presents

In Our Mother’s Garden Brunch

When: June 3rd, 2023 from 12pm-2pm

Come witness the strength, rich history, stories, and more of other women over brunch! Tickets are $100.00 for one individual and $150 for two individuals. By giving an annual gift, you can become part of our amazing network The Lotus Society. The Lotus Society is an exclusive membership of women who have the passion to sow into future generations by supporting our mission to advocate for girls and women in single parent households. Scanning the QR code will provide access to complete the Registration Questionnaire and provide the payment to secure tickets.

Can’t join us, but would like to sponsor other women and families? Sponsorship information will be released to do so.
#bloomupstate #growgirl #brunch #inourmothersgardens #spartanburg

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Camper Information
Camper's Name*
First Name Last Name
Birth Date*
Date Format: MM slash DD slash YYYY
Grade*
Gender*
- Male
- Female
Address*
Street Address City State / Province / Region ZIP / Postal Code
Payment*
- Self Pay
- Scholarship
Parent/Guardian Information
Name*
First Name Last Name
Home Number*
Cell Number
E-mail*
Emergency Information
Emergency Contact's Name*
First Name Last Name
Relationship*
Please Specify Relationship*
Phone Number*
Alt. Phone Number
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Is the camper prescribed an inhaler? If yes, please explain any instructions.*
Informed Consent and Acknowledgement
I hereby give my approval for my child’s participation in any and all activities prepared by during the selected camp. In exchange for the acceptance of said child’s candidacy by ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization
As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
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.
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In Our Mother’s Garden Brunch

In Our Mother’s Garden Brunch

In Our Mother’s Garden Brunch

Camper Information

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

Medical Release and Authorization

Confirmation

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