Yoga Student Class Registration Form:

NEW YOGA FOR PEOPLE WITH PARKINSON’S

Thursdays 2:30-3:30 September 12th - October 31st East side Location: UW -The American Center 4602 Eastpark Blvd. Class held in the Wellness Studio

Course Fee: $75 (covers all 8 weeks)

 

Please complete the registration below:

1. Student Name: *
1. Student Name:
2. Student Address: *
2. Student Address:
Please add your information
Name:
5. Emergency Contact Phone Number: *
5. Emergency Contact Phone Number:
6. Physical Considerations: *
It is important that you speak with your physician about participating in yoga and have been cleared to do so. Do you have your physicians permission to participate in this yoga class?
11. Did someone other than the participant fill out this form? *
If answered yes to #11
*If you would like to pay by check please complete the form and click next . You may exit when it asks for online payment. Please mail a check to: C4CS (Center for Community Stewardship) 354 W Main St. #122 Madison, WI 53703