Registration Form - Yoga for kids

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Participant's name *

Age *

Parent's / Guardian's name *

Parent's / Guardian's mobile number *

Parent's / Guardian's mobile number (Whatsa) *

Parent's / Guardian's email *

Address *

I would like to register for Kids yoga classes, for age group *

5 - 8 years

8 - 14 years

I would prefer to attend the classes on: *

Weekdays (7:45 AM)

Weekends (8:30 AM for 5-8 years; 9:15 AM for 8-14 years)

Both

I will be joining for the classes from________________country. *

I will be joining for the classes from________________city. *

I would like to register for _____ month

February

March

April

May

Clear selection

I came to know about these classes through ________________ *

Friends

Community

Other:

Is there any medical condition? If yes, write a short description. *

Please list the medicines that you are taking, if any. *

Suggested donation per month

200

300

400

Clear selection

Use the following link for donation:

https://donations.heartfulness.org/donation-general-fund

Date *

YYYY

Acknowledge
I am fully knowledgeable of the services that will be provided, as well as my own physical limitations, and I am aware of the related risks and agree to assume the risk of accepting the services or treatments. All the risks shall be borne by me and the service provider shall not be liable or responsible for the same. I acknowledge that if I have any medical conditions or injuries, allergies, medications, physical restrictions that may be affected by or relevant to the services offered, I have the opportunity to discuss such conditions with the service provider. If the services cause me any personal injuries, pain or discomfort, I will immediately advise the service provider of this condition and cease further services. I understand that Heartfulness Institute will make no evaluation nor recommendation - and I will not construe any statement or action as an evaluation or recommendation -with respect to whether I am sufficiently physically fit for the services or treatment requested. I also acknowledge and accept that incase of discontinuation of services, I shall not be refunded/compensated for the same.

I hereby release the Heartfulness Institute from any and all claims, damages, demands, rights or causes of action, present or future, known or unknown, anticipated or unanticipated, arising out of or in any manner resulting from services provided.

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A WAIVER AND RELEASE OF LIABILITY.

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