Children’s Yoga with Ibeliz Guadalupe

Child's Name*

First NameMiddle NameLast Name

Preferred Name or Nickname

Pronouns (She/Her, He/Him, They/Them Etc..)*

Birthday *

Date

Where does this child reside?*

(City/State)

What grade is your child in?*

YesNo

Please tell me your child's favorite color.*

Other Favorite things! Tell me more about your child's favorite animal, food, subject, pass-time, tv show, movie, music, character, happy place. Name it all!*

Please provide information on any food or topical allergies, chronic physical problems or pertinent developmental information relating to your child*

Are there any stressors or worries that may be affecting your child at the moment?*

Please add any additional information that may be supportive for me to know about your child:

Name*

First Name and Middle NameMiddle Name

How did you hear about us?

What is this person's relationship to the child?*

Please provide information on any allergies, chronic physical problems or pertinent developmental information relating to you (parent) and your participation.*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Name

First Name and Middle NameMiddle Name

What is this person's relationship to the child?

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name*

First Name and Middle NameMiddle Name

What is this person's relationship to the child?*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

By signing this participant waiver form, I agree and understand the following:

I expressly acknowledge and understand that there are certain dangers, risks, illnesses and personal injuries inherent in participating in the practice of yoga programs, events, classes, and/or other activities, which may result from unavoidable accidents or injuries, athletic activities, sports programs/classes, the use of any equipment, exercise, or other activities or from my or my minor child(ren)’s or ward(s)’ physical condition.

I understand that Ibeliz Guadalupe assumes no responsibility for loss, damage, illness or injury to person or property that I or my minor child(ren) or ward(s), if applicable, may sustain as a result of my or their physical condition or resulting from my or their participation in any activities or classes.

I expressly acknowledge, on behalf of myself and my minor child(ren) and ward(s), heirs and executors, that I voluntarily assume the sole risk for any and all dangers, illnesses and personal injuries that may result from my or my minor child(ren)’s or ward(s)’ participation of these yoga sessions.

I understand that kids yoga, like all yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension.

I assume full responsibility for any and all damages, which may occur to my child/children through participation in in-person and online yoga classes.

I hereby release, waive, discharge and hold Ibeliz Guadalupe, institutions and partners as harmless from any and all liabilities arising from any untoward incident in my participation to any class, workshop, and relevant sessions which may result to injury, loss, damage, or death.

By signing this form, I hereby represent and warrant that my child and/or I am physically fit and capable to participate for yoga classes, workshop, or activities. I agree and legally bind myself, with full understanding to the contents and meaning of the provisions above.

I hereby represent and warrant that I have the authority to execute this Participant Waiver Form on behalf of myself and/or on behalf of my minor child(ren) or ward(s) as parent, guardian and/or next friend, if applicable.

I expressly acknowledge and agree to the terms and conditions set forth on this Participant Waiver Form. Signature of Parent/Guardian Date of Participant(s) under the Age of 18.*

Please Type name of above signee.*

First NameLast Name

Name*

I expressly acknowledge and agree to the terms and conditions set forth on this Participant Waiver Form. Signature of Parent/Guardian Date of Participant(s) under the Age of 18.

Date*

Date

Children’s Yoga with Ibeliz Guadalupe

Child’s Information

Parent/Guardian Contact Information

Additional Parent/Guardian Contact Information

Parent/Guardian Home Address

Emergency Contact Information

Acknowledgements & Agreements