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Creatively Fit Teens Registration Form
Payment in full for the 8 week session is required before the first class. A Refund of 75% of your payment can be made within a week from the program start date. REFUNDS CANNOT BE PERMITTED AFTER A WEEK FROM THE PROGRAM START DATE.
Please complete all of the required information.
*
Indicates required field
Your Name
*
First
Last
Your Age
*
Email
*
Phone Number
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Please provide your emergency contact information:
Parent's Name
*
First
Last
Cell Phone Number
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2nd Guardian's Name
*
First
Last
Cell Phone Number
*
Please indicate if I have your permission to use photos of you in class on my web site and marketing materials.
Photo Release
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Yes
No
Have you ever done yoga before?
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Yes
No
Please indicate your overall stress level
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I have very little stress.
I have a good amount of stress.
I am really stressed out!
What are some ways that you manage the stress in your life?
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Do you feel that you are spending a lot of time using electronic devices such as TV, internet, video games and cell phone?
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Yes
No
Do you find it difficult to be still and quiet?
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Yes
No
Do you have difficulty sleeping at night?
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Yes
No
Please indicate your overall activity level
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I am very active.
I am active some of the time.
I prefer activities that require no movement.
Please describe the activities and interests that you like to do for fun
*
What is your intention for participating in ths course? What to you hope to gain?
*
Questions or comments
*
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