Form September | NeuroYoga+

Please complete the registration form below.

Child’s Name *

Childʼs age *

Any medical & support needs *

Yes
No

If yes, please describe the medical or support needs

Full name of parent/carer providing consent *

Phone Number *

Email Address *

Media Consent Options (select all that apply) *

Yes, for internal and promotional use
No, I do not give consent

Consent Confirmation *

I confirm that I have read and agree to the policies listed above.
I consent to the processing of my child’s and my personal data in accordance with the Privacy Policy.

Choose your preferred Monday for the trial session (8 Sep – 15 Dec 2025) *

Date of submission *