Request edit access
Kids Yoga Registration & Disclaimer Form
Your information is kept confidential and used only for the purposes of understanding your needs as an individual and to reach you in the event of class changes or cancellations.
Yoga4U - The Yoga & Reiki Studio
Full Name *
Parent’s / Guardian’s Full Name(s): *
Birthdate of Child *
MM
/
DD
/
YYYY
Parent/Guardian's Email *
Address *
Parent/Guardian's Phone # *
How did you hear about us? *
List all known allergies of your child (if any): *
List all medications and supplements if your child takes & reason for each: *
List any special needs or mental health matters that we should know about to help make your child's experience here at Yoga4U better: *
What do you hope that your child will gain from this series of yoga classes? *
Is there anything special about your child that the yoga teacher should know (likes, dislikes, fears, behavioural issues, personality, etc.)? *
How does your child respond in groups? *
How well does your child follow instructions? *
Yoga Class Options:
Column 1
$40 for 4 classes (per month)
$70 for 8 classes (per month)
$12 drop-in class
Class Start Date *
MM
/
DD
/
YYYY
Payment: Cash/E-transfer *
I give permission for my child to be photographed and/or videotaped while participating in the yoga class. These photographs will be the property of Yoga4U and no compensation will be given to my child or me if these photographs are used. I understand the photographs will be used for marketing, public relations, or training purposes only. Parents will be able to view any pictures or videos that are posted on Yoga4U website or social media page.
Consent, Release of Liability Disclaimer & Notices (please read carefully)
I certify that I am the parent or legal guardian and do hereby consent to his/her participation in Yoga4U Kids Yoga Classes. I certify that my child is capable of participating in the yoga class and have disclosed all relevant medical information regarding my child to Yoga4U - The Yoga & Reiki Studio.
This form continues to be effective as long as my child taking classes at Yoga4U or from its instructors in Yoga4U or other locations.
I take complete responsibility for my child's presence at the Yoga4U and I will not hold Yoga4U or any instructors responsible for any injuries or loss my child may incur as a result of his/her participation in yoga classes.
I hereby confirm that I have read and fully understand this release of liability and assumption of risk agreement, fully understand its terms, and sign it freely and voluntarily without inducement.

In signing this release, I have fully informed myself of the content of this release and I have reviewed it and understand what it means, and this release is signed as my own free act and deed.

Consents:
1. I give consent for my child to participate in Inclusive Yoga Classes for Kids at Yoga4U for Children with Disabilities during which they will receive information and instruction about yoga, including yoga exercises/poses, breathing, and relaxation techniques.
2. In the event of injury to my child, I hereby give consent to contact emergency assistance if needed.
3. I understand that the registration fee is non-refundable and that refunds will not be given if a child misses a session. Make-up sessions will only be offered only if Yoga4U cancels a class due to weather or personnel issues.

Parent / Guardian Signature: __________________________________________ Date: ________________________________________

Signature & Date: *
| Yoga4U |Gayatri Pathak|647-628-8241| gpathak13@yahoo.com | 13 Bonavista Drive, Brampton ON L6X 0N2|
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service