Student Name: *

Child's Bithday:

Sibling Name:

Sibling's Birthday:

Parent's Name: *

Mailing Address: *

Phone- Home:

Phone- Cell: *

Emergency Contact: *

Emegency Phone: *

New Student? *

One Trial Class Purchase Only (no session registration) Date/Class/Time *

Class Name and Time Locations: (WS-West Seattle/ Ren-Renton) *

Other Fees: *

Promo Code:

I understand that I will be invoiced for payment within 48 hours *

Photo Waiver: The undersigned agrees to release Bebe Natura, its officers, agents, and employees, from any and all claims, suits, actions, damages, or compensation in any way related to the use and reproduction on photograph(s) taken of me or my child which are used in media publications exclusively for Bebe Natura. *

Liability Waiver: I agree to the participation in the Nurturing Pathways®, Inc. Program for myself and my child(ren). I am aware that the activities of creative movement involve risks for myself and my child(ren). I hereby release Nurturing Pathways®, Inc. from any legal liability and agree not to sue its owners, officers, directors, and employees for any and all injuries caused my participation in the class. I have read and understand the tuition, refund, and missed class policies. Signature: (Please type full name) *