Online Yoga Classes Registration Form

Online Yoga Classes Registration Form

Join the online class and keep your mind and body healthy!
Participant Information
Name*

First NameLast Name
Age*
Gender*

MaleFemaleNon-binaryPrefer not to discloseOther
If the last option is chosen, you may or may not specify.
Phone Number*
Valid Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tell me more about yourself.*
Parent/Guardian Information

For minors (below 18 years of age)
Parent/Guardian Name

First NameLast Name
Phone Number
Email
example@example.com
Relationship
Please only sign if you're 18 years old and above otherwise, leave it blank and have your parent/guardian signed the next signature field.
Signature of Participant

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Date Signed

MonthDayYear
Date
Terms and Conditions*
Parent/guardian Signature

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Date Signed

MonthDayYear
Date
Terms and Conditions
Class Schedule

Please indicate the dates and yoga sessions you wish to enroll in. Please note that the schedules available in this form are only for the months of MAY and JUNE. Updates will be posted for the availability of succeeding classes. You may refer to the calendar guide below.
Calendar Guide
Kindly select the yoga sessions you want to enroll in.*
Other
How do you learn about this online yoga class?*

FacebookTwitterInstagramYouTubeSearch EngineOnline AdsReferralOther
Payment & Confirmation

Kindly confirm the total number of sessions you wish to enroll.
My Products
prevnext( X )
Online Yoga Class EVERY THURSDAY, 8:00PM -9:00PM
$25.00 Quantity

Total

$0.00
The relevant links will be provided in the autoresponder email after you successfully registered.

If you have any questions, please email or call us using the details below:

www.AMindfulTalk.com
A: 7 Franklin Avenue, North Lynbrook, NY 11563
E: info@AMindfulTalk.com
P: (516)-218-2545

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Online Yoga Classes Registration Form

Participant Information

Parent/Guardian Information

Class Schedule

Other

Payment & Confirmation