Registration

To register for our next session, please fill out the information sheet below and submit your payment.

*In order to make the ATN experience as enjoyable as possible for the kids and tweens, please start the conversation of adoption at home. While not all of our sessions are specifically addressing adoption, the topic of adoption is always the underlying constant for the individual groups – just by virtue of everyone in the room having been adopted. This can be highly stimulating for a child or tween where adoption is not an open and approachable topic in the home.

PROGRAMS & FEES:

Parents Group:

$50 for individual sessions

REGISTRATION / DONATION FORM:

Registration Type / Donation Amount*
CHILDREN’S PLAYGROUP
Name of Parent(s)*
First Last
Child's Name*
Date of birth*
Date Format: MM slash DD slash YYYY
Age*
Child’s country of origin*
Address*
Street Address City ZIP / Postal Code Country
Telephone 1*
Telephone 2
Email 1*
Email 2
Child’s Allergies (we occasionally serve snacks)*
Age at time of adoption*
Family structure*
(Single parent, two moms, two dads, mom and dad, etc.)
Level of openness around adoption at home/exposure to adoption related information*
Able to use the rest room independently?*
Able to engage in a single play activity for at least 20 minutes?*
Specific activities liked or disliked*
Any other information that would be helpful for ATN to know about your child?*
How did you hear about ATN?*
Enrolling Session(s)*
Registration Fee*
Price: $300.00
Registration Fee*
Price: $375.00
Registration Fee*
Price: $625.00
TWEEN GROUP APPLICATION
Child's Name*
Child's Date of Birth*
Date Format: MM slash DD slash YYYY
Age*
Name of Parent(s)
First Last
Address*
Street Address City ZIP / Postal Code Country
Child's Country of Origin*
Phone (Parent)*
Phone (Child - if available)
Email (Parent)*
Main reasons for your interest in joining the ATN Group*
Previous participation in any adoption groups?*
Enrolling Session(s)*
Tween Registration Fee (Individual)*
Price: $50.00
Registration Fee*
Price: $375.00
Registration Fee*
Price: $625.00
TEEN GROUP APPLICATION
Child's Name*
Child's Date of Birth*
Date Format: MM slash DD slash YYYY
Age*
Name of Parent(s)
First Last
Address*
Street Address City ZIP / Postal Code Country
Child's Country of Origin*
Phone (Parent)*
Phone (Child - if available)
Email (Parent)*
Main reasons for your interest in joining the ATN Group*
Previous participation in any adoption groups?*
Enrolling Session(s)*
Registration Fee*
Price: $300.00
Registration Fee*
Price: $375.00
Registration Fee*
Price: $625.00
- I understand that my child may leave the All Together Now (ATN) facilities accompanied by Tween Coordinators, ATN staff and volunteers for offsite activities. These could include, but are not limited to: local restaurants, local parks, and local public buildings, such as the library.
- If my child becomes ill or begins to run a fever, I understand that I (or my authorized representative) must be available to pick him/her up.
- I understand that dismissal from the program for unacceptable behavior is at the sole discretion of All Together Now Peer Support Groups for Adoptive Families, and that I (or my authorized representative) must be available to pick him/her up at the activity location within [insert time] of being contacted. Unacceptable behavior includes, but is not limited to, disrespect for other participants or staff, bullying, threatening or causing harm to others, fighting, use of weapons of any kind, use of unauthorized drugs of any kind, and/or failure to follow rules and directions.
- I have explained the rules and expectations regarding behavior to my child.
ACKNOWLEDGMENT OF NOTIFICATION REGARDING RISK AND INDEMNITY AND WAIVER OF CLAIM
Every effort is made to provide participants with a safe, enjoyable, and memorable experience. I attest and verify that my child is physically able to participate in all activities offered at the All Together Now Playgroup. I understand, however, that there are inherent risks in outdoor related activities and travel to and from the site, and, knowing the risks, nevertheless, I agree to assume all risks of personal injury, permanent, temporary, total or partial disability, disfigurement, paralysis, and any other losses or damage to person or property or death,
sustained while my child participates in the activities of the All Together Now Playgroup, including the risk of negligence of the All Together Now Peer Support Groups for Adoptive Families staff and/or volunteers, or hidden, latent or obvious defects in the facilities or any equipment used.

I agree if any claim for personal injury or wrongful death is commenced against All Together Now Peer Support Groups for Adoptive Families (including its officers, directors, members and/or volunteers, employees and mentors), I will defend, indemnify and hold harmless All Together Now Peer Support Groups for Adoptive Families from any and all claims or causes of action for personal injuries, property damage or wrongful death that hereafter accrue, arise out of, result from, or are caused directly or indirectly by my child's participation in the All Together Now Playgroup.

I acknowledge that I have carefully read this document and understand the information therein. I agree to each of the terms and acknowledgments above, and agree to permit my child to participate in the ATN Playgroup activities.
I understand that my child will only be released to individuals whom I authorize below. I further understand that these individuals must present a photo ID to pick up my child. These rules apply in all of the following situations:

a) when he/she is brought back to a drop-off location at the end of the program
b) if he/she must be picked up at an activity location for any reason
(e.g., illness, behavior, family emergency)

(Be sure to include the names of parents/guardians who are authorized to pick up.)
Permission to Photograph
Occasionally, All Together Now Peer Support Groups for Adoptive Families, Inc. program activities may be photographed, videotaped, or audio taped for educational, publicity or fundraising purposes. Please indicate if you give permission for yourself, your children, or any other family members, to appear in videos, photos or audio recordings without compensation (e.g., as part of brochures, slide shows or program websites).
Permission*
- Yes, I give my permission
- No, I do not want to appear in a photograph or videotape.
Parent/Guardian Signature
Name
Date
Date Format: MM slash DD slash YYYY
Effective immediately, I rescind my authorization to be photographed, videotaped, or audio taped.
Parent/Guardian Signature
Name
Date
Date Format: MM slash DD slash YYYY
Emergency Release
If, in the judgment of the staff or volunteers of All Together Now Peer Support Groups for Adoptive Families, the child named above needs immediate care and treatment as a result of any injury or sickness, I hereby give permission to the staff to secure proper treatment for my child. I do hereby consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon or dentist and performed by or under the supervision of the medical staff of the hospital or facility furnishing medical or dental services. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs. I do hereby agree to indemnify and hold harmless All Together Now Peer Support Groups for Adoptive Families (including its officers, directors, members and/or volunteers) from any claim by any person whomsoever on account of such care and treatment of said child.
Parent Group
Name
First Last
Address
Street Address City ZIP / Postal Code Country
Phone
Email
Enrolling Session(s)*
Parent Group Registration Fee (Individual)
Price: $50.00
Tax Deductible Contribution
Contribution amount
CAPTCHA
Date of submission
Date Format: DD slash MM slash YYYY

Email us with any questions: info@alltogetheradoption.org

REGISTRATION / DONATION FORM:

CHILDREN’S PLAYGROUP

TWEEN GROUP APPLICATION

TEEN GROUP APPLICATION

Permission to Photograph

Parent Group

Tax Deductible Contribution