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Yoga for You at Quittie Glen Registration Form

Name  ____________________________________________________________

Phone(s) __________________________________________________________

E-mail  ____________________________________________________________

*I use email for general class information. If you prefer phone/text for emergency cancellations, please note here.

Payment Enclosed  $_________________________   Check # __________________

Medical Conditions ______________________________________________________

Class Days/Times – Please Circle          MON AM                   MON PM                    WED AM              WED PM

Choose a primary day/time but you may attend any class to reach the number you signed up for.   Please indicate if you can make ONLY the one time frame. 

How did you hear about the classes?_________________________________________

Return to:  Denise Smith, Yoga for You, 502 East Main Street, Annville, PA  17003.  Thank you.

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