New to Class- Yogi Participant Registration

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New to Class- Yogi Participant Registration

TMN Kidding Around Yoga with Linda

REGISTRATION- One form per child.

$15/child

Location: Holzer Wellness Center, Gallipolis

Visit The Mindful Neuro website for more mindfulness and kids yoga information.

Email *

Record my email address with my response

Are you a Holzer Wellness Center member?

Provide your membership number and receive 10% off your registration for HWC classes only.

Parent/Guardian First Name *

Parent/Guardian Last Name *

Cell *

Where did you learn about Kidding Around Yoga Classes with Linda? *

Facebook

Holzer Wellness Center

Hope Homestead General Store

I saw a flyer

From a friend/family member who goes

The Mindful Neuro website

Other:

Child's Name *

Child's Birthdate *

If you would like to be added to the Kidding Around Yoga Facebook Group and email list to receive mindfulness tips and information about upcoming events please include your email information below.

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 any class they may participate in to share on social media and flyers for marketing purposes? *

Yes

Required

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

EMERGENCY CONTACT

Full Name

EMERGENCY CONTACT

Phone Number

Payment is expected at the time of registration.

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

Contact Linda with questions:

Email linda@themindfulneuro.com

(740) 577-1678

I understand that my payment reserves my child's space and ensures there are enough supplies for the ability to participate in all activities. I understand that payments are nonrefundable.

I release any all claims for liability for participation in any event or class provided by The Mindful Neuro, TMN Kids, Instructor Linda Phillips, and all teacher associations which includes yoga, exercise, and all other activities and classes for myself and any child I register, whether by heir or chaperone. I recognize the dangers inherent to any program of exercise, movement, and equipment and supplies that may be used. I understand it is my due diligence to consult with a physician prior to engaging in activities, fully accepting personal responsibility for all persons who participate or observe classes and activities. This consent and release of liability will be effective today and for all future classes and events.

I completed my payment.

Required

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