Yoga Balance Registration Page, Yoga Instruction for Adults and YogaKids for Children

Yoga Class Registration Form
Adult / Family / Children's YogaKids

Please print and mail to:
Valerie DeWitt / Yoga Class Registration
7170 SW 116th Terrace
Pinecrest, FL 33156

Checks payable to Valerie DeWitt

Name of Student(s)	_______________________________________
Check submitted by	_______________________________________
Address _____________________________________________________
City __________________	State ________________	Zip _________________
Home Phone ________________ Work Phone ________________________
E-Mail _______________________________________________________

Class Location:
The Yoga Institute	________________ Month
Temple Bet Shira	________________ Month
Specify Class:
______ Adult	______ Family	_______ YogaKids

Registration date received ________________ (for office use only)