DPYP!-Samatone Kids Yoga ~ 2012 Fall Series

REGISTER in advance by September 17, 2012.  Open to all kids - ages 5-12.
Eight Weeks - Wednesday, September 19 thru Wednesday, November 14 (excluding Wed, Oct 31)

10% Early Bird Discount on/before September 17, 2012 ($64 after Sept 17)
10% Early Bird Discount on/before September 17, 2012 ($64 after Sept 17)
10% Early Bird Discount on/before September 17, 2012 ($64 after Sept 17)
Emergency Contact:
How would you like your child to benefit from DPYP! Kids Yoga ?
 you must have at least one item
Improve Coordination
Improve Flexibility
Lose Weight
Increase Confidence
Emotional Stress Reduction
More Self-Discipline
Enhance Athletic Performance
Learn New Skills
Tone & Strengthen
Cardiovascular Endurance
How did you hear about us?
 you must have at least one item
(you were a ) Previous Member
Repeat Drop-In
Friend/Member *
Waiver and Release of Liability
I, as Parent/Guardian of the above-named child(ren) expressly acknowledge that the participation of such child(ren) in Dynamic Power Yoga PLUS! (hereinafter DPYP!) classes, therapies and use of its facilities are undertaken at my/their sole risk; and, in consideration of such use, I agree on behalf of said child(ren), myself, my heirs, successors and assignees to indemnify and hold harmless DPYP! (as used herein, the term “DPYP!” means Total Health through Balance, Inc. (hereinafter THTB), its subsidiaries, successors, assignees, employees, officers, directors, shareholders, and all persons, corporations, partnerships and other entities with which it is or may in the future become affiliated) from any and all claims arising out of personal injury, including illness, bodily injury or death and any property loss or damage suffered by me while utilizing the facilities or services of DPYP!, whether on or off premises. Further, I specifically acknowledge that DPYP! and THTB accept no responsibility for the theft of or damage to my/their personal property left in any areas, anywhere on the property.

I also acknowledge that I have communicated all said child(ren)'s known medical conditions.

I understand:
- There is a 20% Cancellation Fee before September 15, 2012
- There is NO REFUND after September 15, 2012.

I know and understand that my typed electronic signature legally binds me to the terms of this DPYP! Kids Yoga Waiver.

       Mailing Address                                                         Studio Location - DPYP!-Samatone by Suze Curtis
Total Health through Balance, Inc.                            4951 Airport Parkway, #590, Addison, Texas 75001
  14902 Preston Road, #404-586                                       www.DynamicPowerYogaPlus.com
       Dallas, Texas 75254                                                                   972-934-3905

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