Thanks for your interest in Resilient Kids Club, a small-group, neuroscience-informed program created by a licensed school psychologist. All classes run as a 4-week series beginning the week of March 2nd. Group sizes are intentionally small.

 Resilient Kids Club is a movement-based, neuroscience-informed program designed to support children’s regulation, confidence, and emotional wellness in a safe, structured environment.

We intentionally build our groups to help children be successful. This includes:

• small group sizes
• clear expectations and visual supports as needed
• structured routines and predictable transitions
• calm, supportive coaching and coregulation
• sensory tools offered in a planned and supported way
• supervision focused on safety, inclusion, and participation
• adapting activities to match developmental needs and nervous system readiness
• Our goal is for every child to feel safe, supported, and included. If a child needs additional support to participate safely, Resilient Kids Club may add staff support when appropriate and feasible, and/or collaborate with the parent/guardian to create a plan for success.

Resilient Kids Club activities may include (but are not limited to):

• yoga-inspired movement and stretching
• balance and coordination activities
• obstacle courses and structured games
• sensory tools and equipment such as: mini trampoline, scooter boards, balance
• beams, wobble boards, BOSU balls, sensory swing, vibration plate, therapy balls, and other movement supports

To help us create a safe and supportive environment, I agree to share in advance any behavioral, emotional, sensory, or regulation challenges that may affect my child’s participation (for example: elopement/running, aggression, unsafe use of equipment, panic responses, severe impulsivity, or difficulty with transitions). This information helps Resilient Kids Club plan appropriate supports and staffing so my child—and the group—can be as successful as possible.

We take safety seriously and provide developmentally appropriate instruction, supervision, and structure. However, any movement-based activity carries some level of risk, even when safety procedures are followed.

Possible risks may include:

• slips, trips, and falls
• collisions or accidental contact with peers or equipment
• minor injuries such as bumps, bruises, scrapes, or strains
• dizziness, motion sensitivity, or sensory discomfort
• emotional discomfort when practicing new skills in a group setting

By signing and submitting this form, I acknowledge and agree that:

My child is participating voluntarily in Resilient Kids Club activities.
I agree to provide accurate information regarding my child’s medical needs, allergies,

sensory sensitivities, seizure history (if applicable), movement limitations, emotional/regulation needs, and any supports that help my child succeed safely.

I understand the program involves movement-based activities and sensory equipment, and I voluntarily assume all risks related to my child’s participation, including risks related to use of equipment such as trampoline, scooter boards, and sensory swings.

To the fullest extent permitted by law, I release and hold harmless Resilient Kids Club, Joy Melton Psychoeducational Services, and its owners, staff, contractors, interns, volunteers, and affiliates from any and all claims related to injury, loss, or damage arising from participation, except in cases of gross negligence or intentional misconduct.

I understand that if my child’s behaviors create an immediate safety risk to self or others (for example, unsafe use of equipment, running from the group, aggression, or inability to follow safety instructions), staff may pause participation, contact the parent/guardian, request additional accommodations/support planning, and/or discontinue participation if needed to protect group safety.

I understand Resilient Kids Club staff will contact the parent/guardian and/or emergency contact if concerns arise, and emergency services (911) may be called if needed.

Resilient Kids Club staff may provide supportive, non-medical responses to help children regulate and participate safely (for example: sensory breaks, calming tools, movement breaks, breathing strategies, or contacting the parent/guardian). Resilient Kids Club staff do not provide medical treatment.

In the event of a medical emergency, staff may contact the emergency contact listed on this form and/or call emergency services (911).

For the safety and protection of children, families, and staff, Resilient Kids Club may use security cameras in and around the facility.

Security cameras may be used for purposes such as:

• maintaining a safe environment
• monitoring entrances/exits
• reviewing incidents if a safety concern occurs
• supporting documentation related to safety issues

Important notes:

• Security cameras are not used for treatment, diagnosis, or evaluation.
• Cameras may record video, and in some cases may also capture audio depending on camera capabilities and placement.
• Recordings are kept confidential and are not shared publicly.
• Recordings may only be reviewed when necessary for safety, training, documentation, insurance, emergency situations, legal compliance, or lawful requests.

By consenting below, I acknowledge and understand that:

• My child may be recorded while on the premises.
• The purpose of security cameras is safety and security.
• I agree not to request that cameras be turned off during program hours, as they are part of normal safety operations. 

Occasionally, Resilient Kids Club may take photos or short video clips during sessions to highlight the program, celebrate learning, and support outreach and program awareness.

Photos/videos may be used for:

• Resilient Kids Club website
• social media posts (Facebook/Instagram)
• flyers and promotional materials
• newsletters or program announcements

Resilient Kids Club will never share private personal details such as a child’s last name, address, phone number, school, or diagnosis.

Your choice will not affect your child’s experience or eligibility. If you select “No,” your child will still be fully included, and we will make reasonable efforts to avoid capturing their image.

 SMS Communication & Consent

For your convenience, we communicate appointment reminders and important updates through SMS text messaging to the phone number you provide.

SMS Text Messaging Terms

By providing your mobile number and opting in above, you agree to receive SMS text messages from Resilient Kids / Joy Melton Psychoeducational Services related to services and program participation, including appointment reminders, scheduling changes, registration confirmations, and important updates.

Message frequency varies
Message & data rates may apply
Reply STOP to unsubscribe at any time
Reply HELP for help
SMS is not used for emergency communication
Consent is not required to purchase services

Privacy

We respect your privacy. Your mobile number will only be used for communication from Resilient Kids / Joy Melton Psychoeducational Services and will not be sold or shared with third parties for marketing purposes.