New Yogi Enrollment Form (age 2 - 19 yrs)

All information given in this sheet will be treated as confidential.

In consideration of my being permitted to participate in Yoga activities at Just a Piece of Life Studio, I, for myself, my heirs, legal representatives, and assigns, do hereby release said activity, the activity instructor, Taruna Sharma, and any person responsible for organizing and/or overseeing the activity at the location where the said activity will be conducted, from all suits, claims or demands of any kind, which may result from any injury, loss or damage of any kind, arising out of or in connection with my participation in said activity.

Please fill out as much information as possible in all the fields below. More detailed information will help me help you in your yoga practice.
Child's Name *
Child's Birthday *
MM
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DD
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YYYY
Parent/Guardian Name *
Address
Email Address *
Home Phone Number:
Cell Phone Number
Your Child's Medical Information (List allergies, issues or concerns we must know about): *
What benefits would you like your child to realize from his/her yoga practice?
Previous Yoga experience - Style, Duration
Any other sporting or physical activity that your Child participates in?
Hobbies / Interests of your child ?
Photo Release *
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