Yoga with Libby Rose: Registration Form
Thank you for joining in with 'Yoga for Kids & Teens' at Burnside Community Centre.
Please fill out the form below (on behalf of your child / teen) as best as you can, you can always do another later if circumstances change.
It's wonderful for me to know you a little better so we can share this yoga & meditation practice together.
Namaste x
Full Name: *
Email address:
Address:
Mobile / Telephone Number: *
Date of Birth: *
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Emergency Contact & Phone Number: *
HEALTH INFORMATION: *
Please Tick and explain more where applicable
Required
Do you have a medically diagnosed condition under the care of a GP or Specialist? *
If so, has your doctor provided clearance for you to participate in this program? *
Any additional information that you may wish to share for my attention: (I will always respect your privacy)
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