The Mindfulness Practice 
Kids Yoga+ Mindfulness at Mitchell Elementary

This form is for TUESDAYS 3rd, 4th and 5th grade
Mitchell Elementary for 3rd, 4th and 5th grade. Dates- 9/12, 9/19, 9/26, 10/3, 10/10, 10/24, 10/31, 11/7, 11/14, 11/28, 12/5, 12/12. (total 12 classes)

Please fill out this form to register your child for class. Don't hesitate to reach out with any questions- abigailwilber@gmail.com

Below I have a couple details about the class and some questions that will support class preparation. 
Please take a couple minutes to respond with the answers. 
  • The class will be from 3:35-4:35pm. Location TBA
  • Please be sure that your child brings a yoga mat with them. If they do not have one, you can buy one at local stores for as low as $5 (Five Below) or higher at other stores in the area. Towels and blankets work too. 
  • Please include a snack. Students will be given time to eat before class. 
For questions email abigailwilber@gmail.com or visit https://abigailwilber.com/classes
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Name  *
Email *
Child's name *
Child's grade *
Required
Does your child have any allergies? *
Emergency Contact Person Name *
Emergency Contact Person Phone Number *
Who is picking up your child? Is your child going to red rocks?  *
I’d love to know a little bit about your child. 

What are their interests and/or hobbies?

Any challenges either in school or at home, e.g. ability so sustain focus, hard time falling asleep, communicating their needs, emotional regulation, etc?

Anything else you want to share about your child?

What do you hope your child receives from this class?
Do you give permission for your child to be photographed and/or videotaped during class? Pictures would be sent to you and would not be posted on social media without your consent.  *
Required
Is there anything you want to add? 
Health & Safety Disclaimer
 Abigail Wilber is a yoga and mindfulness teacher and is not liable for any injury that may occur during this class. Please consult your physician before beginning this yoga and mindfulness class. This class offers mind and body wellness information and is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice. The use of any information provided in this class is solely at your own risk. 

PARTICIPANT AGREEMENT INCLUDING ASSUMPTION OF RISK, WAIVER OF LIABILITY AND INDEMNIFICATION

I accept the following terms and conditions for the yoga classes and coaching to be provided to me and/or my child by Abigail Wilber. I hereby hold harmless, indemnify, and irrevocably release Abigail Wilber from all claims, demands, and causes of action, related to my or my child’s participation in the yoga classes, which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have. 
1. I attest that I am the parent or legal guardian of the child being registered for private classes, and I have full authority to consent to their participation. 
2. I understand that I am enrolling my child in yoga and mindfulness classes, which involves physical movement, and as such inherent risks. It is my responsibility to notify Abigail Wilber of any medical concerns that may impact my child’s well being during physical movement. 
3. I know that yoga and mindfulness are not a substitute for medical attention, examination, diagnosis, or treatment. I also know that all suggestions made by Abigail Wilber do not constitute medical advice and I am responsible for doing my own research and consulting a doctor before starting any new regimens, including yoga and mindfulness. 

I HAVE READ AND FULLY UNDERSTAND THE ABOVE WAIVER AND ASSUMPTION OF RISK. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE. 
* If a participant is a minor (less than 18 years of age), the parental or guardian registering the child indicates full understanding of the above terms and, as may be permitted by law, is waiving both the rights of the minor participant and the rights of the parent/guardian pursuant to this Agreement. 
Type your name below as acknowledgement and agreement of this waiver
 *
Payment Policy, Cancellations and Withdrawal: 

Class tuition is paid by bank account debit or credit card payment at the time of registration. Cancelled classes will be rescheduled when possible. There are no refunds for missed classes or lessons due to a student absence. You may withdraw the student from the program in the first week of class and receive a refund for unused classes minus processing fees. After the first week, there are no withdrawals or refunds.  To withdraw from a class or lesson please email me with your request. You are not withdrawn until receiving confirmation from me. Please follow up with a call should you not receive an email back to confirm receipt of your withdrawal.

Type your name below as acknowledgement and agreement of this waiver
 *
I agree to all of the above policies and statements. 
Enter your full name below.*


 *
Click the link below to submit payment. Please note: Your student is not registered until payment is received and the form is filled out and submitted. This link will take you to a separate payment page. You will still need to submit this form to complete registration. 


or send venmo payment $240 to- @abigail-wilber
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