Waiver | Kids Virtual Yoga

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Student Name

Student Date of Birth

Parent(s) Name(s)

Primary Email Address

Primary Phone Number

Students Current School

Describe your child's physical limitations, if any.

What do you hope your child will gain from participating in this class?

Briefly describe your child's personality and temperament.

Describe any current problems your child is experiencing at home or at school.

Is there anything else you would like to share about your child?

By their very nature, yoga classes can involve body contact, physical exertion, emotional stress, and/or use of equipment which represents a certain risk. It is recommended that you check with your child's physician prior to their participation.

Kids Virtual Yoga LLC does not provide insurance protection for participants. Please be aware that in registering your minor child/ward for participation in the Kids Virtual Yoga LLC program, you will be waiving and releasing all claims for injuries you or your child/ward might sustain arising out of Kids Virtual Yoga, LLC classes and activities.

By checking this box, you give your child permission to participate in this program or activity and hereby waive, release and forever discharge any and all claims against Kids Virtual Yoga LLC, its employees, or volunteers for damages and/or injuries to the registrant, which may arise from participation and/or instruction in Kids Virtual Yoga LLC activities.

I hereby give permission for images of my child, captured during Kids Virtual Yoga LLC classes through video, photo and digital camera, to be used solely for the purposes of Kids Virtual Yoga LLC publications and promotional material, and waive any rights of compensation or ownership thereto.

Kids Virtual Yoga, LLC respects your privacy, a photo release is not a requirement to attend class.

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