Yoga Club

Registration for Yoga club:

* Indicates required field

Child Name *

First

Last

Child Grade *

Child teacher *

Child's dismissal plan at 3.35pm on the day of the club (bus #, Bowman walker, Rockland walker, MELC, etc) *

Parent/guardian Name *

First

Last

Email *

Phone Number *

Emergency Contact (Name and Phone Number) *

Emergency Contact 2 (Name and Phone Number) *

Name(s) of adult(s) authorized to pick up child after club (your child may only leave with an authorized adult) *

Check here if your child needs to return to MELC after club *

MELC

Name(s) of adult(s) authorized to pick up child after club 2 *

Name(s) of adult(s) authorized to pick up child after club 3 *

In case After School Clubs are cancelled due to weather, how is your child getting home: *

Car line Walker Bus MELC

Medical Physician Name and Phone Number *

Any Medical conditions or injuries? *

I am aware that deliver me wellness is here to serve my child by sharing knowledge of yoga and health. It is my responsibility to ascertain that there is no medical reason to prevent my child's participation. I hereby waive any claim that I might have at any time for injury of any sort that my child may encounter against deliver me yoga, Merion Elementary, or the LMSD. I have carefully read and release, fully understand and agree to the above

All reasonable precautions are taken to assure your child's safety and prevent injuries from occurring. If an incident should occur, you grant permission for the instructor, school or HSA to obtain emergency medical care if it appears necessary.

Agreement to the terms *

"I have read and agree to the terms outlined above."

Comment *

After you click on the Submit button you will be redirected to a page where you will be able to pay the club fees.

Submit