Yoga at School Registration Form

Parent/Guardian Name *
Parent/Guardian Name
Phone *
Phone
Address *
Address
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Child Name *
Child Name
After Club Arrangement *

Please note your child's place will not be secured until payment is received in full. Click the button below to pay online, or contact us at 336-298-4968 to pay by check or cash.