Blueberry Ledge Holistic Arts
119 Highlands Farm Road, Yarmouth, Maine 04096

YOGA PLAY ~ REGISTRATION FORM  

2014

Child's Name_____________________________

M____F____Birthdate_____________________

Address ________________________________

State ___________ Zip Code _______________ 

Home Telephone __________________________

Mother's Name __________________________

Email Address ____________________________

Cell Phone _______________________________

Father's Name __________________________

Email Address ____________________________

Cell Phone _______________________________

I am interested in enrolling my child in Blueberry Ledge Holistic Arts Yoga Play:

___ Wednesday mornings 9-11:30 am

I would like to register my children for the session(s) beginning:
___ January
___ February
___ March
___ April
___ May
___ June
___ July
___ August
___ September
___ October
___ November
___ December 
___ I would like to register my child as "Drop In" and will call 24-hours before the class to determine if there is space.

Please share any information you feel would be helpful to me in working with your child:

Yoga Play fee is $25 per morning, Drop-In fee $12 per hour.  A registration fee of $15 should accompany this application and will be applied to your balance upon the start of your desired session.  There are spaces for 6 children.  If the session is full, you will be placed on the waiting list and your fee can be applied to a future session or can be returned.    

Please copy, print, and fill out the above 2014 Registration Form and mail to Blueberry Ledge Holistic Arts c/o Sue Leonard, 119 Highlands Farm Road, Yarmouth, ME  04096 or call Sue at 207-653-3824 to request a form be sent to you.  You may also email Sue at blueberryledge@maine.rr.com Thank you!