D&D Club Interest Form

Desired Program Location

Which location would you like to be visiting for attending D&D programming? We initially will be running OAP qualifying programming in Newmarket and Orangeville. If you are interested in our Kitchener location please indicate as much. Programming will be available in Kitchener by late 2025.

Location

Newmarket

Orangeville

Kitchener

Other

Attendee Information

First name

Last name

Pronouns

Birthday

Year

Month

Day

Attendee Address

Country/Region

Address

City

Zip / Postal code

Does your child/teen have any challenges or barriers to participation in our programming that could be supported?

Does your child/teen have any support devices that would be helpful to them in enjoying fully our programming?

Do you have access to financial support through OAP, NIHB, MNO or Insurance that you would like to utilize for this programming?

Parent / Guardian Information (Primary Pickup)

Parent / Guardian Full Name

Parent / Guardian Address

Parent / Guardian Contact Number

Parent / Guardian Contact Email

Terms & Policies

Data Use & Privacy

Goblets & Goblins Inc Dungeons & Dragons Clubs have partnered with experts in psychotherapy at Heart & Mind Hub (https://heartmindhub.ca/about/) to blend the magic of Dungeons & Dragons with the science of executive function coaching and therapeutic social learning, creating a new brand of magic. As such, information about the participant will be shared with Heart & Mind Hub to ensure the best outcomes for clients.

Policies

Dungeons & Dragons Club and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless the attendee is unable to participate due to an accident or illness per physician orders or a lockdown/restriction is put in place by the government.

I understand that there is a ZERO tolerance bullying and harassment policy for Dungeons & Dragons Club and that anyone attending this

club will immediately be expelled from attending and their parents/guardians will be called. I will receive no refund or compensation if the attendee signed to this club uses profanity, name calling, racial slurs, general bullying, physicality or/and any other form of harassment towards staff/other club members.

General Indemnity

I, the undersigned*, herby release discharge, indemnify, hold harmless and defend Goblets & Goblins Inc, its officers, employees and servants from any and all liability (claims, demands, losses, causes of action, suits, judgements) of any kind that I or my family may have against Goblets & Goblins Inc due to death, personal injury or illness, loss or damage to property, or future causes that occur during the Dungeons & Dragons Club. In the event of any medical emergency and I or emergency contacts cannot be reached, I authorize and consent for Goblets & Goblins Inc to call for additional medical assistance.

I agree to the terms & conditions