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To enroll, print this page. Fill out and mail printed pages along with payment directly to Buddhaful Kids Yoga, 22 Edmunds Road, Wellesley, MA 02481. Make checks ($150 per session) payable to Buddhaful Kids Yoga. All classes are held at Laughing Dog Yoga Studio (159 Linden Street in Wellesley).

Buddhaful Kids Yoga Class Enrollment Form

Child's Name: ____________________________________________________

Address: _________________________________________________________

Phone: _____________________ Cell: _____________________

Email Address: ____________________________________________________

Enrollment for (check one):

___ Kiddie Yoga at 4:00pm (coed ages 7 to 12)

___ Teen Yoga at 5:15pm (coed ages 13 to 17)

Session (check one): $150

___ Session 1 Tuesdays: Sept 6, 13, 20, 27, Oct 4, 11, 18, 25

___ Session 2 Tuesdays: Nov 1, 8, 15, 22, 29, Dec 6, 13, 20

___ Session 3 Tuesdays: Jan 3, 10, 17, 24, 31, Feb 7, 14, 28

___ Session 4 Tuesdays: March 6, 13, 20, 27 *only $72

Comments/Concerns:

_____________________________________________________

Agreement of Release and Waiver of Liability

I, _____________________________________, hereby agree to the following:

1. That I am participating in the Yoga Classes, Health Programs or Workshops offered by Buddhaful Kids Yoga during which I will receive information and instruction about yoga and health. I recognize that yoga requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga Classes, Health Programs or Workshops. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Yoga Classes, Health Programs or Workshops.

3. In consideration of being permitted to participate in Yoga Classes, Health Programs or Workshops, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program.

4. In further consideration of being permitted to participate in Yoga Classes, Health Programs or Workshops, I knowingly, voluntarily and expressly waive any claim I may have against Buddhaful Kids Yoga for injury or damages that I may sustain as a result of participating in the program.

5. I, my heirs or legal representatives forever release waive, discharge and covenant not to sue Mary Kaye Chryssicas for any injury or death caused by their negligence or other acts.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

___________________________________________________
DATE SIGNATURE OF PARTICIPATE

If participant is under 18:
AS LEGAL GUARDIAN OF ________________________________________, I CONSENT TO THE ABOVE TERMS AND CONDITIONS.

___________________________________________________
DATE SIGNATURE OF PARENTS/GUARDIAN OF PARTICIPANT



	Print this page To enroll, print this page. Fill out and mail printed pages along with payment directly to Buddhaful Kids Yoga, 22 Edmunds Road, Wellesley, MA 02481. Make checks ($150 per session) payable to Buddhaful Kids Yoga. All classes are held at Laughing Dog Yoga Studio (159 Linden Street in Wellesley). Buddhaful Kids Yoga Class Enrollment Form Child's Name: ____________________________________________________ Address: _________________________________________________________ Phone: _____________________ Cell: _____________________ Email Address: ____________________________________________________ Enrollment for (check one): ___ Kiddie Yoga at 4:00pm (coed ages 7 to 12) ___ Teen Yoga at 5:15pm (coed ages 13 to 17) Session (check one): $150 ___ Session 1 Tuesdays: Sept 6, 13, 20, 27, Oct 4, 11, 18, 25 ___ Session 2 Tuesdays: Nov 1, 8, 15, 22, 29, Dec 6, 13, 20 ___ Session 3 Tuesdays: Jan 3, 10, 17, 24, 31, Feb 7, 14, 28 ___ Session 4 Tuesdays: March 6, 13, 20, 27 *only $72 Comments/Concerns: _____________________________________________________ _____________________________________________________ _____________________________________________________ Agreement of Release and Waiver of Liability I, _____________________________________, hereby agree to the following: 1. That I am participating in the Yoga Classes, Health Programs or Workshops offered by Buddhaful Kids Yoga during which I will receive information and instruction about yoga and health. I recognize that yoga requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Yoga Classes, Health Programs or Workshops. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in the Yoga Classes, Health Programs or Workshops. 3. In consideration of being permitted to participate in Yoga Classes, Health Programs or Workshops, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program. 4. In further consideration of being permitted to participate in Yoga Classes, Health Programs or Workshops, I knowingly, voluntarily and expressly waive any claim I may have against Buddhaful Kids Yoga for injury or damages that I may sustain as a result of participating in the program. 5. I, my heirs or legal representatives forever release waive, discharge and covenant not to sue Mary Kaye Chryssicas for any injury or death caused by their negligence or other acts. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. ___________________________________________________ DATE SIGNATURE OF PARTICIPATE If participant is under 18: AS LEGAL GUARDIAN OF ________________________________________, I CONSENT TO THE ABOVE TERMS AND CONDITIONS. ___________________________________________________ DATE SIGNATURE OF PARENTS/GUARDIAN OF PARTICIPANT
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