Name of Student *

First Name

Last Name

Student's date of birth *

MM

DD

YYYY

Name of Parent / Carer *

First Name

Last Name

How did you hear about Teen Yoga *

Facebook

Flyer

Friend

Riverbourne Club

Website

Real Networking

Networking meeting

Other

To complete form you need to read and agree to the terms below. *

I hereby agree to the following: That my child is participating in the Teen Yoga Bananas® Yoga Classes offered by Emily Perrier, Prittie Yoga, during which my child will receive information and instruction about Yoga, breathing, and general well-being. I recognise that exercise requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult a doctor prior to and regarding my child’s participation in the classes if there are already underlying problems. I warrant that my child is physically fit and has no medical condition, which would prevent their full participation in the classes. I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which my child might incur when participating in the classes. I have read the above fully and understand its content. I voluntarily agree to the terms and conditions stated above under my own free will.

Date of Signature *

MM

DD

YYYY