Student Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Parent or Guardian Name *

First Name

Last Name

Phone *

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Liability Release for Parents/Guardians: *

I certify that by signing my name below, I acknowledge that participation in Keep Shining Kids Yoga classes or any other exercise class exposes my child to a possible risk of person injury. I am fully aware of this risk and hereby release any owner or instructors from any and all liability, negligence, or any other claims, arising from, or in any way connected with my child’s participation in yoga and any other exercise class. My signature further acknowledges that I shall not now, or at any time in the future, bring any legal action against Keep Shining Kids Yoga and any owner or instructors and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors and my assigns. My signature verifies that my child is physically fit to participate in yoga classes, or any other exercise classes, and a licensed medical doctor has verified my child’s physical condition for participation in this type of class. My signature is binding to this liability waiver from this day forth.

I AGREE

Today's date *

MM

DD

YYYY

Permission to use photos or video that may include my child for promotional purposes. *

I AGREE

OPT OUT, NO PHOTOS OR VIDEOS, PLEASE

Enrollment is on an automatically reoccuring monthly basis from October 2025-June 2026. If you need to withdraw, please let me know by the 20th of the month to avoid charges for the following month. *

I AGREE