OmBabyYoga Registration Form

Student Name

First Name R Last Name R :

Child's age if applicable

Parent Name(s) if applicable

Street R:

City R State(Abbrev) R: ZIP R:

Home Telephone R:

List any limitations or injuries

Work Telephone

E-mail:

Ten-Week Sessions

Please select one or more of the following and enter the amount in the Total box:

10 Classes............$120 Workshops - (Sundays)
20 Classes............$200    (Call for pricing)
Unlimited..............$275**    Capoeira........................$180 for
Unlimited Family..$350**        10 weeks, $300 for 20 weeks
Drop-in ..................$15       Children's Art ..................___
Capoeira Drop in ..$20       Kirtan w/Tanuj .................___
                                             Tribal Belly dance............___

** Doesn't include workshops

** Packages are good for 3 months
Total.......................................................... R

Please list class or classes you are registering for: (class title, day and time)
R

How did you find us?

Before submitting the form, please use your browser's print command to print the form. After you have submitted the form, please send a check for the total amount to this address:

OmBabyStudio
726A Arnold Ave
Point Pleasant Beach NJ 08742