Kids Meditation Registration Form

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Classes between Dec 5 - Jan 30

Monday - 6.45PM - 7.45PM EST; Wednesday 6.45PM - 7.45PM EST

Monday Class Venue -11801 Emarald Green dr., Clarksburg, MD 20871 (Private Residence)

Wednesday Class Venue -
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2
Photo Release Consent Please check only one of the following: I give my permission for my child’s name
YESNO
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3
Which day are you interested ?* This field is required
Monday 6.45 PM - 7.45PM EST
Wednesday 6.45PM - 7.45PM EST
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4
Child's Full Name* This field is required
First Name
Last Name
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5
Child's Age* This field is required
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6
Parent's Name* This field is required
First Name
Last Name
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7
Parent's E-mail* This field is requiredUpdates will be sent to this email .
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8
Additional Email (optional)Please provide an additional email, if you would want updates to be sent.
example@example.com
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9
Parent's Phone Number* This field is required
Area Code
Phone Number
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Should be Empty: