New Student Information Form

Contact Information:

Child's Name

Age

Parent (full name)

Email

Phone

Address

City, State, Zip

Personal Information:

Has your child practiced yoga before?
 Yes No

List your child’s strengths and areas of need.

Please list any injuries, surgeries, illnesses, allergies or other conditions I should be aware of:

Are there any sensory issues that you feel would impact your child, e.g. going upside down, barefoot, visual or auditory sensitivities?

I release Kathy Flaminio and Core Pilates Studio and will hold them harmless from any and all liability arising out of any personal injuries or damages, foreseeable or unforeseeable, which may occur as a result of my child’s participation in any class.
Initials:

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