Harmony Kids Yoga Registration Form
I am registering for: *
Please indicate preferred payment method *
To Register your Child for Weekly Yoga Classes (in Fort Langley) please indicate which class you are registering for:
For Preschool or School Yoga Please indicate your information below:
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Contact Name *
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Email: (Be sure to check your settings to ensure email doesn't go into SPAM folder) *
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Yes send me the monthly Newsletter for class updates and sales! *
Mailing Address *
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Telephone Number *
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Child's Name and Age
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Emergency Contact Person #1 (Name & Phone Number) *
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Emergency Contact Person #2 (Name & Phone Number) *
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Please enter the names and phone numbers of family/friends that are authorized to pick your child up from Yoga:
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Your Child's Care Card Number:
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Does your child have any: Allergies, Disabilities, Fears, Designations (ADD, ADHD, Autism, Anxiety)
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Medications
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Referral (were you referred by a friend?)
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Program Expectations
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Getting to know your Child (interests, hobbies, fears or concerns)
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How did you hear about Harmony Kids Yoga? *
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Other Comments/Questions
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I declare that my child is physically fit and ready to participate in the Harmony Kids Yoga program. I understand that the Yoga Classes my child and/or I participate in require physical exertion and may cause physical injury. I am aware of the hazardous and risks involved. I agree to take full responsibility for any risks, injuries or damages that my child or I incur or may incur as a result of participation in any class at Harmony Kids Yoga. I will not hold liable Harmony Kids Yoga and/or Harmony Kids Yoga instructors for any accident or injury occurring on or arising from the normal course of the program or due to a pre-existing condition not disclosed by the parent or person responsible for my child. I knowingly and voluntarily waive any and all claims I have, or may have at any time in the future against Harmony Kids Yoga, it’s instructors, and employees for any injury or damage that my child or I sustain as a result of participation in a class at Harmony Kids Yoga. I do authorize emergency first aid care to my child by Harmony Kids Yoga instructors in the event that my child becomes injured or ill during the program. I understand that Harmony Kids Yoga may take photos of classes for future promotional purposes. I understand that my child’s name will never appear along with their photo in any advertising mediums (in print or online). *
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