Register for Creatively Fit Teens

Home
About
Services
shop

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 *

Please provide your emergency contact information:

Parent's Name *

First

Last

Cell Phone Number *

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 *

Yes No

Have you ever done yoga before? *

Yes No

Please indicate your overall stress level *

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? *

Do you feel that you are spending a lot of time using electronic devices such as TV, internet, video games and cell phone? *

Yes No

Do you find it difficult to be still and quiet? *

Yes No

Do you have difficulty sleeping at night? *

Yes No

Please indicate your overall activity level *

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 *

Submit

Home
About
Services
shop