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Little Yoga Friends
Student Information & Liability Waiver
Please complete the form below
Child
*
First Name
Last Name
Birthdate
*
MM
DD
YYYY
Preschool/Grade
*
Preschool
Kindergarten
1st Grade
School
Parent/Guardian
*
First Name
Last Name
Parent Phone Number
*
Parent Email
*
Allergies
Please list any medical conditions/developmental challenges you would like Little Yoga Friends to be aware of:
I would like to be kept informed about Little Yoga Friends and receive emails about upcoming classes and events.
*
Yes
No
Liability Disclaimer & Notices: I individually and as parent and/or guardian of the minor child identified above hereby acknowledge the following notices and grant Little Yoga Friends, LLC the following release from liability: A. I acknowledge and fully understand that I, or my child, will be engaging in physical activities that may involve some risk of injury. I acknowledge and have been advised that it is my responsibility to consult with my or my child’s physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect my or my child’s participation. I assume the foregoing risks and accept full personal responsibility for any personal injuries sustained by my child which might incur as a result or participating in this program and discharge and hold harmless Little Yoga Friends, LLC from any claim, cause of action or liability for damages arising from any personal injury to my child or other persons or property caused by myself or my child’s participation in Little Yoga Friends, LLC yoga program. B. I agree to give Little Yoga Friends, LLC permission to use photographs of myself or my child for any yoga-related promotional materials. I understand that my child will not be identified by name, nor will any compensation be extended for such use. PLEASE TYPE YOUR FULL NAME BELOW TO CONSENT.
*
Thank you!
