ChildLight Yoga

Class Registration Form

REGISTRANT INFO

*All fields in red print are required.

First Name
(adult participant or guardian)
Last Name
Child's Name (if applicable)
Age
Birthdate
Address
City
State
Zip
Home Phone
Work/Cell
Email
How did you hear about this program?
Other Comments?

CLASS/EVENT INFO

Please type as the info appears in the class description/schedule.

Name
Location
Start Date
Start Time
Fee

CONTRACT AGREEMENT *Cancellation Policy:
A space is being held for me in class. If I choose not to / can not continue in yoga class, it is my responsibility to cancel in writing before the 2nd class of the session. I will receive a prorated refund for the classes I do not use, minus a $10 processing charge.

Make Up Policy:
If I miss one class due to illness, vacation, etc., I can make it up during the first class of the following session. I understand there is no guarantee a class will be available for make up and that there will be no reimbursement for missed classes or cancellations due to weather. However, in the instance an instance an instructor must cancel a class due to illness/emergency, a make up class will be scheduled.

Liability Clause:
This is to certify that I, and I as legal parent / guardian with legal responsibility for this participant, do consent and agree to his/her release, for this program. I release and agree to indemnify and hold harmless all instructors, ChildLight Yoga, Bright Horizons at Timberland, and their shareholders, directors, officers, employees, representatives and agents harmless from any and all loss, claim, injury, damage or liability pertaining to my minor child’s involvement or participation in this program, even if arising from their negligence, to the fullest extent permitted by law.

Medical Release:
I hereby give consent for emergency medical care by a duly licensed MD or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of me or my dependent.

Photography Release:
I understand that I or my child may be photographed while having fun in yoga class. The photographs will be the property of ChildLight Yoga and no compensation will be given to my child or me if these photographs are used by ChildLight Yoga. I understand the photographs will be used for promotional purposes only. I also understand I may have a digital copy of any photos taken of my child to be sent via email upon request.

*I HAVE READ, UNDERSTAND AND AGREE WITH THE TERMS, CONDITIONS, AND WAIVERS AS THEY PERTAIN TO THE PROGRAM FOR WHICH I AM REGISTERING. (PLEASE CHECK HERE)

YOGA 4 CLASSROOMS PROGRAM®

Our Yoga 4 Classrooms program bring the benefits of yoga and mindfulness to the classroom environment, helping teachers and students become more centered, focused and learning-ready. School budgets are extremely limited. Your donation of any amount will help us expand this program to more schools. $ ! (THANK YOU!!)

Check here if it would be okay for us to publicly thank you in our Yoga 4 Classrooms program marketing materials, website or newsletter.

CHILDLIGHT YOGA SCHOLARSHIP FUND

Help us grow our ability to share yoga with all children, regardless of family income.

Yes, I would like to donate $ to the CLY Scholarship Fund! (THANK YOU!)

Check here if it would be okay for us to publicly thank you in our newsletter or website.

GIFT CERTIFICATE

I would like a gift certificate in the amount of $

Please put special requests such as an alternative mailing address here:

Our Progams:

Yoga for Kids & Teens
Itsy Bitsy Yoga®
Family Yoga
Mobile Enrichment
Create-a-Class
Summer Camps
Birthday Parties
Yoga 4 Classrooms®
Workshops/Trainings

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