iCare Summer Program 2026 Payment Portal - Integrative Health Services

icare summer skills and wellness program integrative health services therapy and counseling near me

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Child's Name

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Child's Age

Child's Date of Birth (MM/DD/YYYY)

Parent Acknowledgement

By registering my child for the Summer Skills & Wellness Group, I acknowledge and agree to the following: 1. I understand that this is a short-term educational and wellness-focused group experience for children. It is not therapy, counseling, mental health treatment, medical care, daycare, childcare, or a substitute for professional services. 2. Participation does not create a therapist-client, provider-patient, or counseling relationship and does not include diagnosis, treatment planning, clinical records, or any guarantee of a particular outcome. 3. I agree to provide accurate information regarding my child's allergies, medical conditions, medications, dietary restrictions, behavioral concerns, or other information that may affect participation or safety. 4. I understand that my child must be able to participate safely in a group setting. If my child's behavior creates a safety concern or significantly disrupts the group, I may be contacted to pick up my child, and participation may be discontinued without refund. 5. I will not send my child to the group if they are ill, have a fever, vomiting, a contagious illness, or otherwise pose a health risk to others. 6. In the event of an emergency, I authorize Integrative Health Services, LLC to contact emergency services and seek appropriate medical care if I cannot be reached. I understand that I am responsible for any resulting medical expenses. 7. I understand that my child must be picked up promptly at the end of each session. I agree to identify any individuals authorized to pick up my child, and I understand that identification may be required. 8. I understand that all registration fees are non-refundable, including if my child misses sessions, arrives late, leaves early, withdraws, becomes ill, or is dismissed due to safety or behavioral concerns. 9. I understand that participation in group activities involves ordinary risks associated with children's activities. To the fullest extent permitted by law, I release and hold harmless Integrative Health Services, LLC and its employees, contractors, and representatives from claims arising from ordinary negligence related to participation in the program, except where prohibited by law. 10. I understand that staff may be required by law to report suspected abuse, neglect, threats of harm, or other safety concerns to appropriate authorities.

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