Registration Form

Registration Form

This event is a free, community-based experience designed to support mental wellness, connection, and personal growth through gentle movement and guided conversation. Hosted in public spaces, this series offers a relaxed, judgment-free environment where moms can walk at their own pace, connect side-by-side with other moms, and gain clarity through coaching prompts.This is not a fitness class. Water and a light snack will be provided.
Name*

First NameLast Name
Age*

18-2526-3536 -45Over 45
Home Number*
Cell Number*
E-mail*
example@example.com
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
How many children will you have attending with you? Strollers are highly recommended.*

123More than 3
RSVP AGREEMENT, LIABILITY & PHOTO/VIDEO RELEASE (2026)

By submitting this RSVP, I voluntarily assume all risks associated with participating in any Walk & Talk Series events hosted by The Teneka B Brand Five-Star Coaching Company during the calendar year 2026, including light physical activity in public spaces. I accept full responsibility for my own safety and the supervision and well-being of any accompanying children. I hereby release and hold harmless The Teneka B Brand Five-Star Coaching Company, its owner, representatives, and affiliates from any and all liability, claims, or damages arising from participation. I understand this event is not a fitness class, medical service, therapy session, or childcare service, and participation is at my own risk.

Photo/Video Release. I grant The Teneka B Brand Five-Star Coaching Company permission to photograph and/or record me and my child(ren) during Walk & Talk events and to use such images, audio, or video for marketing, promotional, educational, and informational purposes across digital and print platforms without compensation. I understand that I may notify the host in writing if I do not wish to be photographed or recorded. Notify through email ijsdcblog@gmail.com.

By registering, I also consent to receive email and text communications from The Tanika B Brand – Five-Star Coaching Company related to events and coaching services, with the option to opt out at any time.

This waiver applies to all Walk & Talk Series events attended during the 2026 calendar year.
Signature 》》》BY SIGNING AND SUBMITTING THIS REGISTRATION BELOW, I AM AGREEING TO THE RSVP AGREEMENT, LIABILITY & PHOTO/VIDEO RELEASE (026) CLAUSE LISTED ABOVE AND I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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