Spiral Movement Center

Adapted Spiral Praxis Permission Form

Welcome to the ASP Intensive—we hope that your stay with us will be enjoyable and transformative for your child. We request that you fill out the registration form below which contains important information that we’ll need for your stay here. Please note that video documentation is an important part of the therapy process here and if you have any questions or concerns about filming, please don’t hesitate to contact us. Thank you for your interest in our program 🙌

I. Personal Information

Who can be contacted should an emergency arise?

II. Photo/Video Consent and Pick-Up/Drop-Off Information

III. Participant Release Form

I accept responsibility for my child's own medical coverage. I hereby give permission for staff/ volunteers of Spiral Movement Center, to arrange for any emergency medical care including hospitalization and transportation if necessary, and agree to pay for all expenses and cost incurred thereby. If emergency medical care is required, attempts will be made to contact emergency contact person(s) shown above. I agree to release and Indemnify and save harmless Spiral Movement Center, c.o.b. Stephanie Gottlob and Yuji Oka and their staff from all claims arising from whatever participation in any program organized by the staff or volunteers of Spiral Movement Center by any cause whatsoever. Please note that this form with its legal consents and liabilities remains in effect from the date it is signed and will apply to any future Spiral Movement Center programs that the above named participant is registered in unless advised otherwise in writing. I, the undersigned, have read and fully understand the "Participant's Release Form".

IV. Refunds/Cancellation Policy

Due to the logistical requirements necessary for children’s intensives, we require that payment be provided well in advance of your arrival. All intensives are scheduled on a first-come, first-served basis. In the event of a cancellation, we will offer a full refund up to one month prior to the scheduled intensive, and a 50% refund up to two weeks prior. We will not be able to provide refunds after this period.