Grateful Hearts, Calm Minds Class Series Registration

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Grateful Hearts, Calm Minds Class Series Registration

TMN Kidding Around Yoga with Linda

REGISTRATION- One form per child. Dates: November 8, 15, 22 and December 6, 2024

*Make up class on December 13
Location: Holzer Wellness Center, Gallipolis
Contact us at (740) 577-1678 or linda@themindfulneuro.com

Choose a Kidding Around Yoga class to register your child. *

Lil' Yogi (age 3-5) Fridays 12:30-1:00 pm $48

Mighty Yogi (age 6-9) Fridays 1:30-2:30 pm $60

Junior Yogi (age 10-12) Fridays 4:00-5:00 pm $60

iRest Yoga Nidra (age 12-adult) Fridays 3:00-3:30 pm Pay what you can at class

iRest Yoga Nidra (age 12-adult) Wednesdays 5:00-5:45 pm Pay what you can at class

Are you a Holzer Wellness Center member?

Provide your membership number and receive 10% off your registration.

An invoice will be sent via PayPal. Please add the email address associated with your PayPal account.

*If you do not have a PayPal account, please indicate your payment options below.

Parent/Guardian First Name *

Parent/Guardian Last Name *

Cell *

Child's Name *

Child's Birthdate *

List any medical concerns or food/environmental allergies. *

List any behavioral or sensory challenges. What helps soothe when triggered? *

Do you consent to photos/video of your child being taken during class to share on social media and flyers for marketing purposes? *

Yes

Required

I would love to share with you all the ways your little yogi is practicing physical and emotional strength and resilience in my Facebook group, TMN Kidding Around Yoga with Linda and on my website, www.themindfulneuro.com. If you would like to be added, provide your email address below so we can add you to the group & include you in our newsletter!

There may be times where snacks are offered. Please indicate any dietary restrictions. *

None

Vegetarian

Dairy-free

Gluten-free

Sugar-free

Other:

Include anything else you would like me to know about your child.

EMERGENCY CONTACT

Full Name

EMERGENCY CONTACT

Phone Number

Please read and check the boxes below indicating that you understand the registration and agree to the terms outlined below. *

I understand that registration is not complete until payment is received. Refunds will not be issued. If my child misses a class, they may attend the scheduled make-up class.

I acknowledge that physical activity, including yoga, carries the risk of injury. Yoga is not a substitute for medical diagnosis or treatment. I take responsibility for consulting my child’s doctor if needed. My child has no known medical conditions that would prevent their participation in yoga classes. I assume responsibility for any risk or injury that may occur during participation.

I have read and understand the above release and waiver of liability. I agree to the terms and conditions outlined in this acknowledgment.

Required

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