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 Yoga for Kids Registration
Yoga For Kids At The Sandyston Municipal Building
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Today’s Date: *
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First and Last Name of participant: *
Date of Birth: *
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Parent Name *
Address: *
Parent Mobile #: *
Emergency Contact and Number (other than parent above): *
Please list allergies, physical limitations, concerns and goals:
Liability Disclaimer & Notices: please read carefully I individually and as parent and/or guardian of the minor child identified above hereby acknowledge the following notices and grant to Nancy Slyman and Sandyston Township the following release from liability: A. I acknowledge and fully understand that my child, will be engaging in physical activities that may involve some risk of injury. I acknowledge and have been advised that it is my responsibility to consult with my or my child’s physician with respect to any past or present injury, illness, health problem, or any other condition or medication that may affect my or my child’s participation. I assume the foregoing risks and accept full personal responsibility for any personal injuries sustained by my child which might incur as a result of participating in this program and discharge and hold harmless Nancy Slyman and Sandyston Township, from any claim, cause of action, or liability for damages arising from any personal injury to my child or other persons or property caused by myself or my child’s participation in the Kids Yoga classes B. I agree / disagree to give Nancy Slyman permission to use photographs of myself or my child for any Karma Garden Yoga promotional materials. I understand that my child will not be identified by name, nor will any compensation be extended for such use.
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