Registration Form

* Required fields

Parent’s Name: *

Child’s Name:

Address:

Parent’s Email Address: *

Phone: *

Age of Child: 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

What program would you like to sign your child up for?

Why are you interested in having your child take yoga?

What do you hope your child will gain from taking yoga?

Do you have any specific questions for Little Lotus Yoga?

Does your child have any injuries? yes no
If yes, what are they?

Do you have any experience with yoga? yes no

Would you be interested in taking a parent/child yoga class? yes no