Child's Name *

First Name

Last Name

Parent's Name

First Name

Last Name

Phone

(###)

###

####

Are you happy to reflect on your own experience of your first period & menstruation and share a positive, empowering, uplifting piece of advice for all at the blessing?

Yes

No

As the Parent or Guardian of a minor, I confirm that I permit my daughter named above to attend this event.

Yes

No

Photo Release

I give permission for myself or my child to be photographed by Kathleen Paige Adilapuram and give permission for images to be shared online by Kathleen for business use

Yes

No

Yes, as long as her face is not included

Cancelation Policy

If you are no longer able to attend, full refund will be given until 2 weeks prior to event. Otherwise there will be no refunds within 2 weeks of the event date. However, you may transfer your registration to another person or future date.

Yes, I have read and agree

Registration Fee

A registration fee of $275 will be required before completing your registration. Once this form is submitted you will be automatically sent to a payment page. If any trouble with payment occurs please contact me within 24hrs to resolve the issue and complete your registration. If there are special financial circumstances which you would like us to consider please check below. If you would like to pay it forward for an additional girl to attend who may not have the financial means to pay the registration fee, please check the box and we will contact you.

I have read, and understand

I have special financial circumstances I would like to discuss before paying

I would like to pay for an additional girl to attend who may not have the means to pay