Student Name First Last
Student's Birth Date (mm/dd/yyyy)
Student's School Name
Grade —Please choose an option—PreschoolKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Classroom Number (if you know it)
Student's Gender —Please choose an option—malefemaleother
Student's Identity Preference
Teacher'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
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
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