Student NameFirst Last
Student's Birth Date mm/dd/yyyy
Grade ---PreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Classroom Number (if you know it)
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.
Parent NameFirst Last
Address Line 2
My child has permission to participate in daily walks supervised by the instructor in the surrounding neighborhood and parks. I understand that there may also be an opportunity for goat petting on these observation walks. YesNo
My child has permission to share snacks 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 Cancellation Policy