Welcome to GROW!

We're excited to welcome you to GROW Adult Assisted Activity Center! Please complete the Participant Registration form below to help us better understand each participant's needs, preferences, and important health and safety information. This information allows our team to provide a safe, supportive, and engaging experience for everyone at GROW.

GROW Participant Registration

Strength Starts Here

Participant profile – GROW Adult Assisted Activity Center

Participant name

Date of birth

Phone

Street address

City

Zip code

Parent/guardian(s)

Attending aide/agency (if applicable)

Emergency contacts

Emergency contact #1

Relationship

Phone

Emergency contact #2

Relationship

Phone

Health and participant information

Health/medical concerns

Sensitivities, triggers, or aversions

Allergies (including type of reaction and necessary intervention)

Can the participant be left alone?

Yes

Permission for emergency medical treatment

In the event of an accident, injury, or serious illness, I request that GROW Adult Assisted Activity Center first attempt to contact me or the participant’s parent/guardian. If GROW is unable to reach me, I authorize GROW to obtain emergency medical treatment from an appropriate local medical provider and to make arrangements deemed reasonably necessary, including transportation by ambulance at my expense.

Participant/parent/guardian name

Signature

Date

Photo, video & media release

I give GROW Adult Assisted Activity Center permission to photograph, video record, audio record, or otherwise capture the registered participant while participating in GROW activities, programs, and events.

As the participant or the participant’s parent/guardian, I authorize GROW Adult Assisted Activity Center and its authorized representatives to use and reproduce the participant’s name, image, likeness, voice, photographs, audio, and/or video in printed or electronic materials for purposes including sharing GROW activities, promoting future events, and supporting the continued growth of GROW Adult Assisted Activity Center.

Participant/parent/guardian name

Signature

Date

Get in touch today

We’re glad you’re here. Reach out to learn more, ask questions, or see how GROW can support your loved one in a caring and welcoming environment.