Neurodiverse Kids Yoga Registration Form

A gentle, sensory-friendly class offering visual cues, calm movement, and space for every child to shine at their own pace. Parents or aides welcome.

Schedule:

Wednesdays, 5 to 5.45 PM

* 50% can be claimed as a tax-deductible contribution

* Please help by submitting your donation receipt for an employer matching gift. Utilize the Employer Matching Gift search tool.

First Name *

Last Name *

Date of birth *

Email *

Address

City

State

Postal code

Phone *

Parent's Full Name *

Gender *

Male

Female

Other

Please provide information about your child's current health status, any known allergies, and any ongoing medications. *

Customers/Students Photos and Videos During Class *

Yes

I acknowledge and grant UPFNA and their representatives permission to use my child/children's image, voice, and recordings in various formats, including video and still images. I understand that this content may be copied, exhibited, published, or distributed without any expectation of compensation. I acknowledge that these recordings may be displayed online or in public, and this permission has no time limit. This release specifically applies to the recordings of the session listed on this document. I have read and understood this release and agree to its terms. I release UPFNA and its representatives from any claims related to the legitimate use of these materials.

Liability Waiver - Parent or Guardian sign on-behalf of the student *

I Agree

I understand, acknowledge and appreciate that, as with any physical activity, there is some risk of physical injury and damage associated with my participation in meditation and I assume such risk. I represent that I am in good health and suffer from no existing physical impairment/injury or i have disclosed any accordingly. In consideration of the privilege of participating in the yoga program sponsored by Universal Peace Foundation California, I hereby release, discharge and relinquish Universal Peace Foundation California, and its respective officers, directors, volunteers and employees, of and from all claims, demands, actions, and causes of action of any sort, for any injuries sustained in connection with my participation in the yoga program offered by Universal Peace Foundation California. I also express sincere desires for my to learn simple focus & meditation techniques as part of the curriculum. I understand that this technique is being taught to me/ my kid for the purpose of attaining inner peace, bliss, satisfaction and contentment (Santhosham). I promise that I will not disclose the meditation/focus techniques or other yoga instructions/asanas/postures taught (to me) to anyone without the written consent of UPF Cal. I have read the above release and waiver of liability and fully understand its contents.

Communication Terms and Condition *

I Agree

I fully understand and agree to receive Email/Phone calls/SMS messages from Universal Peace Foundation California for communicating like class timings changes due to weather or other reasons, new/upcoming events, UPF India programs and important announcements. Unless otherwise required by law, I understand that UPF Cal never shares any contact info to anyone outside of the organization for any marketing purposes.

Pay via this link:

https://www.zeffy.com/ticketing/neurodiverse-kids-yoga

Paid *

Yes

Payment Plan Selected *

Yearly

Monthly Recurring

First/One Month

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