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Registration Form

Student Registration Form

 

Child’s Full Name: …………………………………………….…………………… Boy/Girl

Date of Birth: …./.…/…..… Age:……yrs Class……………………………………………………….

Parent/Carer’s Full name:………………………………………..………………………………………………………...

Address:………………………………..……………………………………….………. Post Code:……………..

Contact Numbers: Home: ……………..…………….………… Mob:………………………………………………

Email:……………………………………………….

In the case of an emergency please provide a second guardian’s details:

Name & Address…………………………………………………………… Tel:…………………………………………

Has your child done YogaBugs or Yoga’d Up before? Yes/No

If Yes please state when and where they did the course:……………………………………………………………….

Known allergies/physical Limitations/Concerns:…………………………………………………………………………

Venue: ……………………………………….. Day and Time …………………… Start Date: ………………………

How did you hear about YogaBugs/Yoga’d Up?………………………………………………………………………

From time to time YogaBugs would like to send you additional relevant information about YogaBugs/Yoga’d Up and yoga for children, if you do not wish to receive this information please tick here

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I acknowledge that I have read, understood and agreed to the Terms and Conditions of Contract below.

Parent/Guardian Signature: ………………………………………………… Date:…/…/……..

To book a place on a YogaBugs or Yoga’d Up class, please return this booking form completed along with a cheque for £xxxx ( £xx for xx YogaBugs / Yoga’d Up Classes and £xx registration fee) or £xx if you already have paid a registration fee. Please you’re your cheque payable to: K.Jackson and write the name of the child on the reverse of the cheque. THIS SECTION NOT APPLICABLE TO THE DROP IN CLASSES FOR AUGUST 2007

If you have any questions or want to check that there are still places available in the class of your choice do not hesitate to call or email me.

Liability Disclaimer & Notice

  

I individually and as parent and or/guardian of the child identified above hereby acknowledge the following notice and grant to Karen Jackson the following:

 

Liability

 

Refund Classes

 

IF YOU DO NOT UNDERSTAND ANYTHING SET OUT IN THIS FORM PLEASE SPEAK TO KAREN JACKSON ON 0115 9870605 OR 07845906392 BEFORE YOU SIGN

For Teachers Use Only: Name: ……………................... Teaching Centre: ………………………….

 

Course Dates:…………………………………………..…. Level Taught:………………….

 

.: Prorated refunds will be given if cancellation is made in writing before the second attended class of the series. There is a £10-processing fee for refunds if you cancel a series of classes. I understand and agree that I will not receive any refund or credit for missed classes, but if cancellation of a class is due to failure on the part of YogaBugs I will be entitled to a reasonable refund of the charge for that class.   Release: YogaBugs Limited ("YogaBugs") takes all reasonable care in ensuring that its programmes are safe. However, I agree that my child will be engaging in physical activities that may involve some risk of injury. I acknowledge I have been advised to consult with my child’s physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect my child’s participation in the YogaBugs programme. I assume the above risks and accept responsibility for any injury sustained by my child and discharge and hold harmless YogaBugs Limited its owners, officers and personnel including its teachers and its suppliers from any liability arising from any injury to my child or other persons or property caused by my child’s participation in the YogaBugs programme. If that injury is caused either by my or my child's own fault, or by a third party unconnected with YogaBugs' provision of services, or by events which YogaBugs Limited its owners, officers and personnel including its teachers and its suppliers could not have foreseen or prevented even if they had taken all reasonable care.