Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Classes *

Please Select Which Class You're Signing Up For

Spring Yoga Club

Child 1 Grade *

Kindergarten

1st

2nd

3rd

4th

5th

Child 2 Grade

Kindergarten

1st

2nd

3rd

4th

5th

Emergency Contact *

First Name

Last Name

Additional Authorized Pickup Contact

First Name

Last Name

Liability Release *

I, as the parent or legal guardian of the child(ren) identified above, consent to their participation in the after school Yoga & Mindfulness class. The instructor will take all reasonable care to ensure the classes are fun and safe; however, I understand that they will be engaging in some physical activity and therefore may involve some risk of injury. I assume these risks and take full responsibility for any personal injury sustained by my child which might occur as a result of participating in this program. I agree to discharge Kaitlyn Cautero from any claim, cause of action or liability relating to any incident that may occur in connection to our participation in the above mentioned yoga class.

Yes

Media Release *

I give consent for my child(ren) to be photographed or filmed while participating in the yoga class and for photos and videos which include images of my child(ren) to be used by Kaitlyn Cautero for promotional purposes. I understand that they will not be identified by name, nor will any compensation be extended for such use.

Yes

No

Fee:

$135/student After submitting this form you'll be redirected to a payment page.