Kids Yoga Registration Form

Kids Yoga Registration Form

Welcome to our Kids Yoga Program! We’re excited to have your child join us for a journey of mindfulness, movement, and fun. Please fill out the form below to register for kids Yoga classes. This form will help us gather important details to ensure your child’s safety, comfort, and the best yoga experience. We look forward to seeing your child on the mat!
Child’s Full Name

First NameLast Name
Child's Date Of Birth

MonthDayYear
Child's Health & Safety Information: (Please select)

Allergies (e.g., food, environmental)Medical conditionsPhysical limitationsAny specific needs or accommodations
Is there any relevant information we should be aware of regarding your child (e.g., allergies, medical conditions, or special requirements)?
These details will be used as the emergency contact information for your child:
Parent/Guardian’s Full Name

First NameLast Name
Phone Number
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Culture Of wellness?
Please select the classes your child would like to attend in November 2024:

Wednesday 20th Nov - 3.30-4.30 pmFriday 22nd Nov - 3.30-4.30 pmWednesday 27th Nov - 3.30-4.30 pmThursday 28th Nov - 3.30-4.30 pm
Please select the classes your child would like to attend in December 2024:

Wednesday 4th Dec - 3.30-4.30 pmThursday 5th Dec - 3.30-4.30 pmTuesday 10th Dec - 3.30-4.30 pmThursday 12th Dec - 3.30-4.30 pmWednesday 18th Dec - 3.30-4.30 pm
I have a child with a sibling who will also be attending yoga classes and understand that I will receive a 10% discount on the fees for the second child’s classes.
Sibling's Full Name:
Would you like to receive information about our Summer School Holidays Yoga, Art, and Mindfulness Retreats? If you’re interested in registering your child, please tick 'Yes,' and I will send you more details by email along with the registration form.

Yes, I am interested.No, I am not interested.
Release and Waiver of Liability:

In consideration of permitting my child to participate in kids' yoga classes provided by Culture of Wellness (Instructor: Cindy Brugier Sharma), I, the undersigned parent/guardian, hereby:

Release and Discharge: Release and discharge Culture of Wellness, Cindy Brugier Sharma, and any associated instructors, employees, agents, or representatives from any and all claims, liabilities, damages, or expenses, including but not limited to personal injury, property damage, or loss arising directly or indirectly from my child’s participation in the yoga classes.

Indemnification: Agree to indemnify and hold harmless Culture of Wellness and Cindy Brugier Sharma from any claims, actions, or demands brought by or on behalf of my child, or arising from my child’s actions during or in connection with the yoga classes.

Acknowledgment of Risk: Acknowledge and understand that participation in kids yoga classes involves certain risks and hazards. These risks may include, but are not limited to, physical injury, falls, strains, sprains, and other unforeseen accidents. I voluntarily assume all such risks on behalf of my child.
Date

MonthDayYear
Date
Signature

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Thank you for enrolling your child in Yoga classes with us at Culture of Wellness! You will receive your invoice along with a payment link via email. Please be sure to check your spam folder as well.
We look forward to seeing your child on the mat soon!
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