Registration and Waiver
Please complete this registration form and waiver to enroll your child in KIds Yoga for Wellness classes. Enrollment is not complete until payment is received. Class size limited to 8 students.
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Email *
First name of Participant *
Last name of Participant *
First Name of Guardian/Primary Contact *
Last Name of Guardian/Primary Contact *
Email address of Guardian/Primary Contact *
Cell phone for Guardian/Primary Contact *
Second phone number for Guardian/Primary or Secondary Contact
Age of Participant *
Birthdate of Participant (month/date/year) *
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Address *
Emergency Contact Full Name *
Emergency Contact Phone Number *
Preferred class (class size limited to 8 participants) *
Yoga mat options *
Payment options: $60 for classes plus $30 registration fee if your child brings her/his own mat to class. $60 for classes  plus $45 registration fee if YFW provides a mat for your child. I will pay via: *
In addition to other risks, I know that the Coronavirus (COVID-19) pandemic is a global risk to human health. According to infectious disease experts, COVID-19 is highly contagious, has a mortality rate many times greater than the flu, and can spread easily and exponentially. While people of all ages are at risk of catching COVID-19, persons with compromised immune systems and older persons may be at particular risk. With this knowledge I hold Yoga for Wellness, LLC harmless for my decision to attend or for my child to attend in-person yoga classes on or after September 1, 2020. *
Required
Specific to COVID-19, I understand and will abide by “Ohio Restart Responsible” for Fitness Venues and Yoga Alliance standards for responsible indoor yoga classes. https://coronavirus.ohio.gov/static/responsible/Gyms-Dance-Instruction.pdf and https://yourya.org/wp-content/uploads/2020/04/Guidebook_Opening_Up_Best_Practices-1.pdf. Specifically, I agree to: (1) conduct self-assessment or assessment of my child and not attend Yoga for Wellness classes if I/s/he exhibit/s symptoms or known exposure to COVID-19 in the past 14 days, (2) I will maintain six foot social distancing from all others, and (3) I will wear a mask for indoor yoga classes. *
Required
Additionally, I take full responsibility for informing myself about all risks related to COVID-19 and assessing those risks; I understand that attending Yoga for Wellness classes in person involves risks related to COVID-19 that I assume solely and expressly; I agree and understand that it is my responsibility to protect myself and others by washing hands with soap and water, using hand sanitizer, avoiding face touching, practicing social distancing, avoiding gathering in groups, wearing gloves and masks where possible, and avoiding touching shared surfaces. I represent that to the best of my knowledge, when I attend class, I am not currently afflicted with, and have not knowingly been in contact with someone afflicted with COVID-19 within the last 14 days; I am not experiencing a fever or signs of respiratory illness such as cough, shortness of breath or difficulty breathing, or other COVID-19 symptoms; I understand that persons may be afflicted with COVID-19 and not exhibit symptoms, not be aware that they are afflicted, and/or may not voluntarily agree to disclose their condition; and I expressly release Yoga for Wellness, LLC from any and all liability of any kind related to COVID-19. I assume all risks, known or unknown, related to attending in-person Yoga for Wellness, LLC classes  during this pandemic. *
Required
As to all these risks, I do hereby waive (for myself, my executors and administrators) any and all rights to claims for damages arising from any illness including but not limited to COVID-19, injury, accident or occurrence caused by or as a result of my participation in or connection with Yoga for Wellness, LLC, its instructors, agents, representatives and/or facilities. I shall not hold Yoga for Wellness, LLC responsible for the loss or theft of my personal items. I assume all risks, known or unknown, for myself and anyone in my vicinity related to and/or arising from my environment while participating in class. I release Yoga for Wellness, LLC from all liability to the fullest extent allowed by law. *
Required
I declare that I have either consulted a physician or voluntarily chosen not to consult a physician before or during my participation or my child's participation in yoga classes. I now declare that I am or s/he is in good health. *
Required
I understand that there are specific risks of physical injury that may result from my or my child’s participation with Yoga for Wellness, LLC, and I voluntarily assume the risks associated with such participation. I declare I have either consulted a physician or voluntarily chosen not to consult a physician before or during the course of the program. I have been warned that each student must be in good health to participate in the program and I now declare that s/he is in good health.  I understand efforts will be made for me to be contacted if medical attention is required during class time.  I give permission for Yoga for Wellness, LLC instructors to seek emergency medical treatment for my child if they deem necessary. *
Required
I permit the student to attend and participate in all Yoga for Wellness, LLC activities and events. It is understood yoga instruction involves kinetic corrections, which may include physical touch as part of regular class work and rehearsals. I shall not hold Kara Garrod, or Yoga for Wellness, LLC responsible for the loss or theft of each student’s personal items. I shall indemnify, hold harmless and defend Kara Garrod, or Yoga for Wellness, LLC against any and all claims, actions, or suits brought for damages or alleged damages, and from all liability, loss and expense, including reasonable legal expenses, resulting from any injury to person or property or from loss of life sustained by my student while s/he participates in classes and activities on the premises of Wyoming Fine Arts Center, or other areas where these activities may take place. *
Required
I understand that Yoga for Wellness, LLC does not give credit and/or refunds for class(es) missed due to holiday, vacation, illness, weather, etc. I understand the instructor may choose to offer video and/or zoom classes if it is not possible to conduct yoga classes in-person outside or indoors due to the State of Ohio or Wyoming City Schools’ response to the pandemic, and it is my decision to have my student participate in online classes. I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. *
Required
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above. I certify that I am the Parent or Legal Guardian of the stated minor. *
Required
I have had sufficient opportunity to read this entire document. By selecting "Yes" in response to each paragraph, I acknowledge I have read and understood it, and I agree to be bound by its terms. *
Required
I acknowledge that by filling out the signature line below, this acts as my legally binding signature. *
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