CLASS SELECTION FORM (Classes are filled first-come, first-served.) Full
payment must accompany the registration form and must be received at least one week prior to the
first day of classes.

Student's Name ____________________________________________
Age   __  Grade  ____
Street Address ________________________________________________
City/State/Zip _________________________________________________
Home Phone Number ______________________ 
E-mail * very important * ___________________________
Parents’ Name(s)_______________________________
Phone Number Where Parent(s) Can Be Reached During Class ___________________
Medical conditions or allergies ____________________________________
Food allergies or intolerances _____________________________________
Anything else you would like us to know about your child _____________________________

Please read and sign the following. Your signature indicates you have read, understand and agree to comply with the statements listed here.

I release Prana Center, Prana Productions and staff from all liability in connection to any personal injury and/or damage to or loss of personal property while engaged in class activity or walking to/from class. In the event of a medical emergency, I grant the staff permission to engage in first aid (if trained) and if necessary to transport or have my child transported to the nearest Emergency Medical facility.

It is my responsibility to cover any fees resulting from a check which has been returned by the bank. My money will be refunded only if I or my child cannot be registered due to overenrollment or cancellation. I understand that classes must be taken in the current semester; they may not be made up in future semesters.

I give Prana Center and Prana Productions permission to use pictures of myself or my child in publicity and/or on their website or other associated electronic media.

Date ____  Signature of Parent/Guardian ______________

[ ] Winnie-the-Pooh Performance Workshop (Grades 2-5) Fee $169
[ ] Yoga & Hip-Hop (Grades 1-5) Fee $99
[ ] Teen Yoga (Grades 6-12) Fee $129
[ ] Early Elementary Yoga (Grades
[ ] Cabaret Singing & Performance (Grades 4-12) Fee $129FULL
[ ] Nicholas Nickleby Performance Workshop (Grades 3-5)  Fee $169 FULL
[ ] Monologue and Scene Study (Grades 3-8) Fee $99
[ ] After School Acting - Tuesday afternoons (PreK-Grade 2, ages 4 and up) Fee $56FULL