Student Registration

Child’s Name
DOB*
Phone Number*
E-mail address*
Medical Conditions
Food Allergies
Parent/Guardian #1
Name
Phone#
Relation to child
e-mail
Street Address
Parent/Guardian #2
Name
Phone#
Relation to child
e-mail
Terms of Agreement:
Form of Consent:*
- I find it acceptable for my child to participate the in activities provided by Kula Yoga Kids, LLC. By initialing below, I agree that is in no way responsible for the safekeeping of my child’s personal belongings while attending class. I understand that classes at may be physically strenuous and I voluntarily allow participation in them with full knowledge that there is risk of personal injury, property loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise.
Release of child:*
- I understand that I and/or the authorized person picking up my child MUST show a valid photo ID to the staff of Kula Yoga Kids LLC and sign the child out on the sign-out form in order for child to be released to their custody. Any person other than those listed on the child’s profile that pick up MUST be cleared with a staff member of Kula Yoga Kids upon drop-off.
Media Release:*
- I hereby give my child permission to be photographed during the Kula Yoga Kids After School Program and Yoga classes and for those photos to be used in news media and promotional segments, and to publish videos or audio transmissions for advertising, websites, public information, DVDs, and any other lawful purposes. I understand that although my child’s photo may be used for advertising, his/her identity will not be disclosed, and I do not expect compensation and that all photos/videos are the property of Kula Yoga Kids LLC and it’s affiliates.
Transportation Release:*
- I hereby give permission for the transportation of my child for the Kula Yoga Kids After School Program and its activities by modes of transportation agreed to by the program organizers.

Parent/Guardian #1

Parent/Guardian #2

Terms of Agreement: