Kids Yoga Waiver & Release Form

Kids Yoga Waiver & Release Form

Kids Yoga Waiver & Release Form
- Child's Name
  
  First NameLast Name
- Age
- Birth Date
  
  MonthDayYear
  Date
- Parent/Guardian Name
  
  First NameLast Name
- Parent Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Parent Email
  example@example.com
- Special Notes (Anything the teacher should be made aware of - allergies, injuries, etc.)
- Emergency Contact (someone other than parent/guardian listed above)
  
  First NameLast Name
- Relationship to Child
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Media Release
  
  I hereby give permission for images of my child, captured during the Kids Yoga class, taught by Heather L. Joyce, through video, photo, and digital camera, to be used solely for the purposes of advertising and marketing promotional material and publications, and waive any rights of compensation or ownership thereto.
- Signature
- Date
  
  MonthDayYear
  Date
- Injury Release
  
  By signing below, I release the instructor (Heather L. Joyce) from any injury to my child or damage to my child's property that occurs while attending or as a consequence of attending a Kids Yoga class.
- Signature
- Date
  
  MonthDayYear
  Date
- Should be Empty: