Fall Registration FormSeries starts on Sept. 17th, 2025 at 1:45 p.m. Registration Welcome! Thank you for choosing Fall After School Enrichment Yoga & Gardening Series! Limited space is available. Registration is first come, first served. Please complete one form per child. This form serves as a planning tool for In Bloom KYG. Once your form is filled out, click NEXT to take care of payment. For questions please email InBloomKidsYoga@gmail.com. We will do our best to respond with in 24 hours. Child's First, Last Name and preferred pronouns if any * First Name Last Name Preferred pronouns * She/Her, They/Them, Him/His She/Her They/Them Him/His Other name Date of Birth * MM DD YYYY Grade Level and Name of School * Please list any allergies and reactions and if the child carries a one or two hypodermic devices such as an Epipen, prescriptions or other medications * Include food, plants, bees and/or creams or ointments (not including sunscreen). Child's home address * Address 1 Address 2 City State/Province Zip/Postal Code Country Primary Caregiver's Name * First Name Last Name Primary Caregiver's email * Primary Caregiver's phone * (###) ### #### Primary caregiver #2 name First Name Last Name Primary caregiver #2 email Primary caregiver#2 phone (###) ### #### Emergency Contact name * First Name Last Name Emergency Contact Phone * (###) ### #### Emergency Contact #2 name First Name Last Name Emergency Contact #2 phone (###) ### #### Consent, Liability Release and Photography Agreement Please read and give consent: I, individually and as parent/guardian of the minor(s) identified above, hereby acknowledge the following notices and grant In Bloom Kids Yoga & Gardening, Seattle Park and Rec and City of Seattle P-Patch and their host studios the following Liability Release: I acknowledge and fully understand that my child and I will be engaging in physical activities that may involve some risk of injury. I acknowledge that I have been advised to consult with my and my child's physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect our participation in the In Bloom KYG program, class, workshop or sessions. I assume the foregoing risks and accept personal responsibility for any personal injury sustained by myself or my child and discharge and hold harmless In Bloom KYG and SPR, City of Seattle P-Patch and their host studios from any claim, cause of action or liability for damages arising from any personal injury to my child or other persons or property caused by my or my child’s participation in the In Bloom KYG program, class, workshop or sessions. Photographs: I acknowledge that my child and I may be photographed during In Bloom KYG classes and these photographs, which shall be owned by In Bloom KYG, may appear in In Bloom KYG promotional materials unless otherwise specified. No person whose photograph is used will be identified by name, nor will any compensation be extended for such use. I have read the Consent, Liability Release and Photography Agreement. Yes, I give consent. Tell us anything else that you feel would be good for us to know about your child. Emotional, physical, strong opinions, likes dislikes, friends/peers etc. Thank you! Thank you for submitting the registration form. If you have any questions, please contact us at InBloomKidsYoga@gmail.com. We will do our best to respond in 24 hours.
