Please fill out the form below. After submitting the form, you will be forwarded to our secure payment page.

Please select the class you or your child will be participating in.
Participant Information
Child 1 Name *
Child 1 Name
Child 2 Name
Child 2 Name
Child 3 Name
Child 3 Name
Child 4 Name
Child 4 Name
Contact Information
Parent 1 Name *
Parent 1 Name
Parent 2 Name
Parent 2 Name
Home Phone *
Home Phone
Work Phone
Work Phone
Cell Phone *
Cell Phone
Additional Information
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Authorized Drop-Off/Pick-Up Name
Authorized Drop-Off/Pick-Up Name
Authorized Drop-Off/Pick-Up Phone
Authorized Drop-Off/Pick-Up Phone
Permission to Participate *
I hereby give permission for my child to participate in the above class. While all reasonable precautions will be taken to assure my child’s safety and to prevent any injuries from occurring, I will not hold the instructor or the PTA and its officers and members liable for any accident, which may occur. My child and I understand that if, after one warning, any student is: a) unable to maintain appropriate behavior in class; or, b) not picked up promptly after class that student will not be allowed to attend the remaining sessions scheduled for that class. I understand that parents will be notified at the time of the warning and before a child is removed from class. Refunds will not be issued for any student so removed. In addition, I grant permission for the instructor and/or PTA officials to obtain emergency medical care (by calling 911) for my child if it appears necessary. We do not offer refunds for tuition paid once a session has begun, but will provide a credit towards future Experiencing Yoga programs when warranted.

Kids' Day Off – When School's Out We're In!
Come and enjoy a fun-filled day of inner and outer science.
Find out more at www.ioworkshop.org