Yoga and Mindfulness Registration for Schools

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Email *

Parent/Guardian 1 Name *

Parent/Guardian 1 Phone Number *

Parent/Guardian 2 Name *

Parent/Guardian 2 Phone Number
*

Email *

Emergency Contact (First and Last name) *

Emergency Contact Phone Number *

Child Last Name *

Child First Name *

School *

Elon Park Elementary

Rea Farms STEAM Academy - Elementary

Rea Farms STEAM Academy - Middle

Thales Academy

Charlotte Preparatory

Other (Specify Below)

Other School

Grade Level *

Name of the Teacher *

Does your child have any special needs, physical limitations, or a recent surgery?

Will your child attend afterschool? *

Yes

Does your child have any allergies? *

Name of people authorized to pick up child (other than parents) *

Submit

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