Kids YOga Application & Consent

Thank you for applying for Kids Yoga at Three Queens Yoga. We are excited to engage with your children with the benefits of yoga, mindfulness, and movement practices. The following applications allows our instructors to learn a little more about your child(ren) so we can best meet their needs. If you have questions, please email, Wesley Blades, CRYT, at:

Child/Childrens Name *
Child/Childrens Name
Parent/Guardian Name *
Parent/Guardian Name
Address *
Phone *
Child's Physician *
Child's Physician
Medical History
How would you rate your child's physical fitness? *
Behavior and Conduct
Three Queens strives for inclusivity and openness for all children. However in order to create safety, acute behavioral issues will not be tolerated. Parents will be notified if situations arise, and expected to empower their children's cooperation in programming. *
I consent to photography and video of my child for promotional use. *