Soothe & Move Class Registration

Register for a Soothe and Move Class

November 17 at Roots Academy from 10-11am. Located at 2 Davis Point Ln, Cape Elizabeth, ME 04107.

"*" indicates required fields

You are registering for the Soothe & Move class on Nov 17, 2024

one child (age 5-12) + one caregiver

Price:

Tell us about you and your child!

Child's Legal Name*

First Last

Child's Preferred Name & Pronouns (She/Her, He/Him, They/Them, etc.)

Child's Age*

Parent/Legal Guardian's Name*

First Last

Parent's Preferred Name & Pronouns (She/Her, He/Him, They/Them, etc.)

Phone*

E-mail*

Emergency Contact Name*

Emergency Phone*

Mind & Body Information

Is there anything we should know about your mind or body before our class?*

Any injuries/allergies?*

Is there anything else we should know about you or your child/children?*

Session Goals

If you could wave a magic wand, what would you hope this class helps with?*

Class Referral

How did you hear about this class?*

Newsletter

Would you like to be added to the Roots Up monthly newsletter for classes, trainings, and tips to soothe the nervous system?*

Yes

No

Photo/Video Release

I give Roots Up permission to take photographs or videos of me or my child during the class for promotional purposes.*

Yes

No

Waiver Form*

I Accept

By clicking "I accept," I acknowledge that I understand and agree that self-soothing strategies are not substitutes for medical attention, examination, diagnosis, or treatment, and that Roots Up (Radiant Beginnings, LLC) and its instructors are not providing medical advice or treatment. It is my responsibility to notify the Instructor of any illness or injury before I or my child begin classes. I hereby assume full responsibility for any risks, injuries, or damages of any type, known or unknown, direct or indirect, which I or my child might incur as a result of participating in the class. I waive all claims against Roots Up (Radiant Beginnings, LLC) and its instructors for any injury to myself, my child, or others as a result of participation in the class. This Release of Claims is intended to be as broad as applicable law permits. By agreeing, I release all potential claims on behalf of myself and/or the child I am authorizing to participate.

Total:

Payment Method