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Yoga & Mindfulness for CHildren:
Student information Form
The aim of this form is to gather some essential details that will enable me to tailor a yoga program that aligns perfectly with your needs and objectives. If you have any questions, please feel free to reach out to be directly.
First name
Email
Address
Child's Name
Child's Name
Child's Name
What is the name of the person retrieving your child after class?:
What is their relationship to your child?:
Last name
Phone
Relationship to Your Child:
Child's Date of Birth
Child's Date of Birth
Child's Date of Birth
What is the password they will need in order to retrieve your child? (If your child is in the Woodentots After-School Program, please have this password be the same password I will need to use in order to retrieve your child.)
How is your child’s general health and well-being? (Please answer for all your children):
Has your child had an operation or any health issues that may have a bearing on their Yoga practice?
*
No
Yes
If “Yes” please give more details here:
Does your child or have a doctor’s permission to participate in intense physical activities:
*
No
Yes
What do you hope your child will learn from their Yoga and Mindfulness class?
Please tick the box if you would like to receive access to special blog posts and resources containing information related to children's yoga and mindfulness.
Photos offer a wonderful way to capture the magic of our yoga sessions and can be used for various purposes, including documentation and promotion. Please tick the box if I have permission to document your child's journey and share it with others on social media in order to promote the benefits of children’s yoga and mindfulness.
Parent Declaration: I can confirm that I have answered all questions honestly and that the information given is correct.
I have read and agree to the terms and conditions as presented by Holistic Healing Arts, -->
Terms & Conditions
Your Signature
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SUBMIT
Thank you for submitting your form!
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