Bikram Yoga Portsmouth - Child Care Waiver

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How much water do you drink during class?

	None
	0-12 ounces
	12-24 ounces
	24-32 ounces
	I bring a gallon jug and pour it over my head.

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Official Bikram Info

Bikram Yoga Portsmouth Childcare Waiver of Liability


Child's Name:	In diapers?
Birth date:	Permission to use bathroom alone?
Special Notes:	Allergies:



Child's Name:	In diapers?
Birth date:	Permission to use bathroom alone?
Special Notes:	Allergies:



Child's Name:	In diapers?
Birth date:	Permission to use bathroom alone?
Special Notes:	Allergies:



Parent/Guardian Name:
Address:
Phone:
Driver's License #:	State:
Alternate Phone:
Emergency Contact:	Phone:
Relation to Child:

I, ________________________, understand that by signing this waiver I release and hold harmless Bikram Yoga Portsmouth, C+P Gallagher's Properties and any of its employees, trustees, childcare providers and agents from any liability as a result of personal injury or property damage occuring while the above child/children is/are in their care at Bikram Yoga Portsmouth.




I understand that childcare services are provided only while I am present in the building and taking class.

I understand that childcare service and costs are separate from my membership at Bikram Yoga Portsmouth and payable in cash or check only to the childcare provider.


I understand that if my child should become unconsolable during the class session, I am responsible to leave class and attend my child.


I have read and understand the Bikram Yoga Portsmouth Childcare Policy.


Signature of Parent or Guardian		Date

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Schedule Notes
Join us for our annual Memorial Day Potluck, Monday, May 31st! Bring your family and friends! ************** Childcare available: Monday 4:30pm, Wednesday 9 am and Friday 9am! ************** For the latest holiday and emergency weather cancellations, join our email list or call the studio and press #2.

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603-430-6222
801 Islington Street, Portsmouth, New Hampshire 03801

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