Classes Release Form

I

give consent for
to participate activities at Yoga Playhouse Summer Camp. I understand that some recreational activities involve an element of risk or danger of accidents. I agree to assume those risks and waive, release, and discharge any and all claims for damages for personal injury, property damages resulting from said risk—except in the case of gross negligence.

Please List any Food Allergies Your Child has

I give my consent for my child/children to be treated by any emergency medical personnel, physician, or surgeon, in case of sudden illness or injury while participating Yoga Playhouse summer camp. I understand Yoga Playhouse will provide no medial compensation for such treatment.

Please provide the name and phone number of your child's Pediatrician
Pediatirican's Name
Pediatirican's Phone Number

Photo Release
I authorize Yoga Playhouse to publish photographs taken of me and/or my child for use on Yoga Playhouse website, social media and advertising materials. I attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize Yoga Playhouse to use their photographs. I acknowledge that since participation in publications and websites produced by Yoga Playhouse is voluntary, neither the minor children nor I will receive financial compensation.

Street Address

City, State, Zip Code

Email (required)

Name and Ages of Minor Children:
Child's Name / Age

Child's Name / Age

Child's Name / Age

Child's Name / Age