Student Name First Last
Student's Birth Date mm/dd/yyyy
Grade —Please choose an option—PreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Student's Gender —Please choose an option—malefemaleother
Student's Identity Preference
School's Name
Returning Student? YesNo
List any special things you would like me to know about your child before she/he starts class to make her/his experience feel more supported.
What makes your child unique and special among all the stars in the universe?
Parent Name First Last
Street Address
Address Line 2
City
State
Zip Code
Country
Parent's Email
Parent's Phone
Permissions:
My child has permission to participate in daily walks supervised by the instructor in the surrounding neighborhood and parks.YesNo
My child has permission to share sunscreen with friends during camp.YesNo
My child should NOT eat the following foods.
Are there any previous injuries, medication, or allergies that the instructor should be aware? Please list here.
People Authorized to pick up your child
How did you hear about us? My child’s schoolI saw your flyer around townA current or former studentMy child loves your classesA friendGoogleOther - please describe below
If you chose "Other" above
I have read and agree to the Honey Heart Kids Yoga Waiver of Liability
I acknowledge that I have read and agree with the Refund Policy
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