Summer Yoga 2024 Registration

Child's Name (one child per form please)*

First NameLast Name

Age (12 or above only) *Kids Group CLOSED (Maximum Capacity)/Teen Group OPEN

Parent/Guardian's Name*

First NameLast Name

Parent/Guardian's Email*

example@example.com

Parent/Guardian's Cell Phone*

Please enter a valid phone number.

Emergency Contact Information*

Name

Relationship to child

Best number to call in an emergency

Please list the name, phone number and relationship, of those allowed to pick up your child. *

Please select one of the options below:

My child will be dropped off and picked up from the program by myself or one of the individuals designated above.For High School participants only - I grant my child permission to travel to and/or from the program independently.

Summer Fitness Program Parent Consent and Waiver

I have voluntarily enrolled my child in a fitness program offered through YES Community Counseling Center. I recognize that the program may involve physical activity including, but not limited to, core and lower extremity strength focusing on proper alignment and neuromuscular control, and other various fitness activities.

I hereby affirm that my child is in good physical condition and does not suffer from any known disability or medical condition which would prevent or limit participation in this exercise program. I understand that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or exercise program, or initiating a substantial change in the amount of regular physical activity performed.

I understand and am aware that fitness activities and use of equipment involve a risk of injury and I am voluntarily allowing my child to participate in these activities. I also understand and am aware that strength, flexibility, and aerobic exercise, including the use of equipment, are potentially hazardous activities.

By signing this waiver, I hereby release YES Community Counseling Center from any and all claims, costs, liability and expense for any injury, loss or damage whether known, anticipated or unanticipated arising from my child’s voluntary participation and enrollment.

Signature*