8-12 y.o. Shine From Within Enrollment Form

Shine From Within: Girls Ages 8-12 Circle Registration
Shine From Within! Girls Circle for ages 8-12. There will be 4 Circles total. Dates: November 4, 11, 18 & December 2 from 5:45-7pm at Yoga Landing.
For more info, visit our event page on Facebook: https://www.facebook.com/share/16xRWSFs1k/
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
MEDICAL INFORMATION
Allergies*
Phone Number
What would you like us to know about your daughter so we can best support her during circle? Any Familial, Medical or Mental Health Concerns?
Payment
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Shine From Within (4 sessions @ $30 each)
$120.00 Quantity

Sliding Scale option for a family with financial difficultyWe have one spot available per session for someone with financial hardship.
$60.00 Quantity

Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
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Shine From Within: Girls Ages 8-12 Circle Registration