Family Fun Yoga at Westfield Library
Parent/Guardian Name(s) *
Your answer
How many family members (including you) will be participating in Family Yoga? *
Your answer
List all participants below *
include age of child(ren)
Your answer
Parent/Guardian Primary Phone Number *
ex: 3035551234
Your answer
Parent/Guardian Secondary Phone Number
ex: 3035551233
Your answer
Parent/Guardian E-mail Address *
Your answer
I would like to register for (select class option below) *
check all that apply; class is 11:30-12:00 Mondays February 5-March 19 *no class February 19
Required
Photo Release *
I hereby permit Silly Hearts Yoga for Kids the full rights to use any photographs, videos, essays, artwork or any other product produced by me or my child(ren), or having myself or my child's likeness. I grant Silly Hearts Yoga for Kids the rights to use these items for advertising, brochures, websites, and other promotional materials. I understand that I will not be able to examine the materials and will not hold Silly Hearts Yoga for Kids liable for any distortions. I also understand that I will not receive payment for Silly Hearts Yoga for Kids using me or my child(ren)s likeness. I understand that these materials will not be sold or distributed.
Required
Medical Release *
In Case of An Emergency I give my consent to Silly Hearts Yoga for Kids to seek medical care for the aforetomentioned students should it become necessary. I hereby give my consent to trained medical professionals to administer emergency medical treatment to my child(ren), should sickness or injury occur.
Required
Liability Waiver *
I hereby waive any and all liability of Silly Hearts Yoga for Kids, the contractors, employees, agents and/or owners that may arise on the premises, or in class including illness, injury or death. I authorize Silly Hearts Yoga for Kids, the contractors, employees, agents or owners, to instruct my child(ren) in yoga and related activities while I recognize and understand the inherent dangers associated with such activities. I understand that there is an assumption of risk that my child(ren) are taking during yoga and related activities. Should it become necessary for Silly Hearts Yoga for Kids or someone on Silly Hearts Yoga for Kids behalf to incur attorney's fess and costs regarding my child(ren)'s participation in this activity, I agree to pay Silly Hearts Yoga for Kids' reasonable costs and attorney's fees if Silly Hearts Yoga for Kids is not held liable for me or my child(ren)'s injuries or damages. I certify that I have adequate insurance to cover any injury or damage I or my child(ren) may cause or suffer while participating, or else I agree to bear the costs of such injury myself.
Required
Payment agreement: please initial below *
A 6-week series is $45 per family. By initialing below I understand that Silly Hearts Yoga for Kids will send me an invoice for all classes and that payment is due on or before the first day of class.
Your answer
Parent/Guardian Signature (typed) *
Your answer
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