MONTHLY COACHING GROUPS

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Child's Name
First Name
Last Name
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Date of Birth (to determine eligible participation)
Date
Year
Month
Day
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Parent / Guardian Legal Name
First Name
Last Name
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EmailPrimary Email Address: Our primary method of communication is email -- by providing your email, you agree to be added to our communications list. You can unsubscribe at any time.
example@example.com
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Phone Number
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Home AddressWe take this information for sending birthday cards, certificates, gifts, and for emergency contact reasons.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Other
Country
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Carefully Choose Your Workshop / ProgramRegistering more than one child from the same family? Please email us first - family discount is available! ashley@ashleyanjlienkumar.net. Please note that after you submit this registration form, you should be redirected to our payment page to complete your registration. If you are not, please contact us at the email provided.
Sensational Self-Confidence & Soaring Self-Esteem - Online
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Liability Waiver and Disclaimer:ALL PARTICIPANTS - Liability Wavier; please read carefully. Glossary: "Club/Studio" refers to South Asian Arts Movement Society, The Balance Code Yoga & Wellness Ltd. and The Confidence Coach, and Ashley Anjlien Kumar, and any associated partners/representatives involved in the class/event. Assumption of Risk of Injury and Wavier of Claims: I assume all risks of injury and waive all rights to pursue money damages or any other relief of any kind as a result of anything occurring at or near the Club/Studio location or any other venue used by the Club/Studio or its employees, officers, directors or other representatives (including but not limited to dance and/or fitness instructors and/or personal trainers and/or artists managed by the Club/Studio and/or contractors of any type). In the event I am injured while on a property the Club/Studio uses to conduct classes, performances, or workshops, I will hold harmless the Club/Studio and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns from all claims of any sort for damages or relief, including but not limited to claims for contribution. I acknowledge there is possible danger connected with any physical activity (including the dangers of physical injury and death) and knowingly and voluntarily waive my right to make a legal or equitable claim of any sort against the Club/Studio and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns from all claims of any sort for damages or for other relief, including but not limited to claims for contribution. This assumption of risk and wavier of liability applies to my family members, successors, heirs, and assigns. Physical Condition and No Medical Advice: I represent that I am in good physical condition and have no medical reason or impairment that might prevent me from my participation or intended use of the Club/Studio and the services offered. I acknowledge that the Club/Studio and all of its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns will not and cannot provide me medical advice relating to my physical condition and ability to use the facilities/participate in programs/classes. If I have any health or medical concerns now or after joining a class, I will discuss them with my doctor before attending & participating in any classes or using the Club/Studio"s services. Death/Disability Clause: If I die or become totally or permanently disabled, upon reasonable written notice to the Studio/Club Owner of the death or disability, either I or my estate may cancel this agreement and receive a pro-rata refund for my unused sessions/classes. Cancellation and Refund: To cancel this agreement, the client must notify the Club/Studio Management in writing. FINAL SALE - NO REFUND; if for any reason the participant cannot complete the program, you may transfer the program to another suitable candidate who will benefit from the program. I, the undersigned, waive and release the Club/Studio and its owners, shareholders, directors, volunteers, sub-contractors, employees, agents, representatives, successors and assigns from any and all claims in any way connected with my participation. This agreement is binding on my heirs and executors. I understand that ALL aspects of this wavier apply to any children that I bring with me to any of the classes/programs/events/meetings or gatherings offered or facilitiated by Club/Studio. I acknowledge that I am the legal guardian of the child(ren) listed on this form (if any). By signing this document, I acknowledge that I have read or heard this document in its entirety and that I fully understand it. I have asked any questions that may have occurred to me and have been answered to my satisfaction. A legal guardian/parent must sign for any participants under the age of 18 years. Your typed signature below will be considered identical to your actual signature if this form is submitted electronically.
Clear
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Standard Photo & Video Release Form for Minor Children:I agree to grant to The Confidence Coach o/a The Balance Code Yoga & Wellness Ltd. and Adventures in Wisdom, Inc. and its authorized representatives permission to record on photography film and/or video, pictures of my participation and/or the undersigned minor children. I further agree that any or all of the material photographed may be used, in any form, as part of any future publications, brochure, or other printed or online materials used to promote The Confidence Coach and Adventures in Wisdom, and further that such use shall be without payment of fees, royalties, special credit or other compensation. I release The Confidence Coach (o/a The Balance Code Yoga & Wellness Ltd.) and Adventures in Wisdom, Inc. from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize The Confidence Coach (o/a The Balance Code Yoga & Wellness Ltd. and Adventures in Wisdom, Inc. to use their photographs, videos and names (names can be omitted if written notice is provided). If you agree, complete our signature. If you do not agree, your child's face and body may be blurred out for use in publications. If you do not agree, please type "Do not Agree" in the box below.
I agree.
I do not agree.
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How did you hear about us?
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PLEASE NOTE: Your payment will be processed under our official parent company name The Balance Code Yoga & Wellness Ltd. After clicking "Submit" you'll be redirected to our secure payment processor.

Make-up classes for ANY registered programs are not provided. We also require a minimum number of participants to run certain group programs - you will be advised as to the status of your program. Thank you!
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