Registration
Mindful Movement for November 2020 - You only need to register one time to be included for the entire month. Family fee $25 per month. Join us on Zoom for 8 classes on Mondays and Thursdays in November live from 11:00-11:20 am EST (a recorded version will also be available.) *Prior to the first class you will receive a zoom link which will be the same for all 8 classes as well as a specific webpage and password to access the recordings.
Event:
Start Date/Time: End Date/Time:
Fee per Family: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
relation to student
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info
(Not Contact #1 or #2)
 
 
 
Questions/Options:
Please share names and ages of children in your family who will be joining us.*
 
Additional Information:
 
Liability Waiver
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments: