Form
Lil Wonders Kids Yoga
Registration Form
Parent/ Caregiver Name
Last Name
Parent/Caregiver Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Number
Please enter a valid phone number.
Parent/Caregiver Email
example@example.com
Emergency Contact Details
First Name
Last Name
Phone Number
Please enter a valid phone number.
Child Name
First Name
Last Name
Child's Date of Birth
-
Month
-
Day
Year
Date
Does your child have any health issues?
Is your child on medication?
Please Select
If Yes, Please give details
Does your child have any allergies? If yes, Please give details
Are there any cultural factors that need to be considered?
Any abilities that we need to know about?
Any other information we need to be aware of(emotional, behavioural, learning difficulties, additional needs etc.)
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Please E-Transfer payment of $120 (6 sessions):
lwkidsyoga@gmail.com
Submit
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