Registration Form for Children's Program
Email address *
Please fill in the information below to register your little Yogi(ni) to our Children's Program! All personal information will remain strictly confidential.
My Little Yogi(ni)
First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Gender *
Language *
Parent / Guardian
Name *
Your answer
City *
Your answer
Phone *
Your answer
Emergency Contact Information
Please list details of someone to contact in case of emergency.
Name *
Your answer
Relationship *
Your answer
Phone number *
Your answer
Health Information
Please indicate if child currently has any of the following conditions: *
Required
If you have checked any of the above, please give details.
Your answer
Allergy History
Please indicate if child currently experiences any of the following allergies *
If you have checked any of the above, please give details of the nature of the allergy and the treatment required in case of emergency
Your answer
How did you hear about us?
Please choose from options below *
Comments
Please share any questions or comments you may have.
Your answer
Agreement
• I understand that what is taught during the Yoga workshops/classes are only for the child's personal practice, therefore will not teach to others.
• I understand that Isha Hatha Yoga are tools for healthy living, but the workshops are not a substitute for medical attention, examination, diagnosis or treatment.
• I understand that Yoga practice includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension.
• As is the case with any physical activity, the risk of injury is always present and cannot be entirely eliminated. Teaching will be done with attention and caution, and child can express any discomfort and seek out the teacher's advice.
• Yoga is not recommended and is not safe under certain medical conditions, therefore I will provide accurate information about the child's health condition.
• I hereby willingly wish for the child to attend this program completely. I take full responsibility for the result and indemnify the teacher, Hera Baboudjian, against all claims and suits. I will not communicate the contents of the program, either directly or indirectly to anyone else. I understand the participation guidelines and agree to follow them.

I hereby agree with the above statements and I declare that the above information is true, accurate and complete to the best of my knowledge. *
During our programs, we sometimes take photos for our portfolio / promotion /web content. At the end of the program we also take a group photo which can be shared on our website or social media. If you do not wish for the child to be photographed, or give permission for these intent, please let us know. *
Date *
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Thank you! It will be a pleasure to have you join our Program!
Once we receive your completed Registration Form, we will email you to confirm this, along with details on payment modalities. Please make sure you have shared your correct email address and please contact us at hathayogawithhera@gmail.com in case you have not received any confirmation email in the following few days.
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