• Fit Kids Registration and Release 9/9-11/18

  • Child's Date of Birth:*
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  • Is the participant a current BAC patient?
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  • I have spoken to a BAC clinician to confirm that this group is an appropriate fit for my child. (Required prior to registration)*
  • In Case of Emergency...

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  • I, the undersigned parent or legal guardian of the above-named child, give permission for my child to participate in group at the Boston Ability Center.

    I understand that group at the Boston Ability Center is a recreational activity that may include the use of therapy/gym equipment, therapy tools, and play structures. I acknowledge that participation in physical activities carries inherent risks, including but not limited to falls, collisions, and other injuries.

    I certify that my child is physically able to participate and does not have any medical condition that would prevent safe participation, or that I have disclosed any such conditions to Boston Ability Center staff.

    In consideration of my child being allowed to participate, I agree to the following:

    1. Assumption of Risk - I knowingly and voluntarily assume all risks and responsibility associated with my child’s participation in BAC group activities.
    2. Release of Liability - I release, waive, and discharge the Boston Ability Center, its owner, employees, therapists, other staff, and any partners of the program from any and all liability, claims, demands, or causes of action arising out of or related to any injury, loss, or damage that may occur during participation.
    3. Rules and Conduct - I agree that my child and I will follow all posted rules and staff instructions. Failure to do so may result in removal from the activity.

    I certify that all of the information provided on this application is correct and true to the best of my knowledge.

  • Date:*
     - -
  • Photo and Video Consent Form

    (optional)
  • I hereby grant The Boston Ability Center permission to use my child’s likeness in a photograph or video in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of The Boston Ability Center and will not be returned. I hereby irrevocably authorize The Boston Ability Center to edit, alter, copy, exhibit, publish or distribute photos or videos for purposes of publicizing The Boston Ability Center’s programs or for any other lawful purposes. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein the likeness of my child appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of photographs or videos. I hereby hold harmless and release and forever discharge The Boston Ability Center from all claims, demands, and causes of action which I, my heirs, representatives, administrators, or any other persons acting on my child’s behalf may take. 

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Consent Form for Assisting with Toileting Needs

    Version: 2023
  • BAC staff are committed to meeting the needs of all children and working collaboratively with families to help children achieve their toileting goals. As such, BAC staff are happy to assist children with toileting as needed and will take all reasonable precautions to ensure the safety, privacy, and dignity of each child when providing toileting assistance. Depending on your child's needs, this may include tasks such as diaper changing, helping a child access the toilet, assisting a child with wiping or managing clothing, assisting a child with hand washing, and/or changing a child following an accident. 

  • Please indicate your preference by checking the appropriate box below:*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Payment

  • Please select which session(s) you would like your child to attend:

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                        • Payment Methods

                          Choose from one of the PayPal options to make your payment.

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