Yoga Student Class Registration Form:

New Yoga For All Class on Saturdays!

10 week series. Dates: Week of November 9th - January 11th

This class accommodates instructions to make yoga accessible for those with special needs. We accept IRIS funds for payment.** 

This class will include standing, kneeling and poses done lying down.  Should be able to get up from the floor with minimal assist. Caregivers welcome!

 

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 If you plan to pay with IRIS funding: IRIS Consultants please contact Iris Mickey at yogamickey@gmail.com with reauthorization and payment information.