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Please print out/mail to Prana, 21
Charles St., Holliston, MA 01746 w/payment.
Student’s name
____________________________________________________
Student’s age _____ Grade
(entering) ______ Gender ____
T-shirt size: [ ] Child Large [ ] Adult Small [ ] Adult Medium [ ]
Adult Large
Second Student’s name_____________________________________________
Second Student’s age _____
Grade (entering) ______ Gender ___
T-shirt size: [ ] Child Large [ ] Adult Small
[ ] Adult Medium [ ]
Adult Large
Medical needs or
allergies_________________________________________
Learning style/anything you'd like us to know about your child.________
________________________________________________________________
Parents’ Name(s)_________________________________________________
Address__________________________________________________________________
Home phone Number
Please list as many numbers you can in the unlikely
event of an emergency:
Parent name _____________ Parent Cell Phone __________________
Parent work phone ______________
Second Parent Cell ___________________
Work Phone
__________________ Emergency Contact __________________________
Student's email __________________ Parent email __________________
How did you hear about this program?___________________________
| [ ] Session A (July 14-25) $675 |
$ |
| [ ] Session B (Aug. 4-15) $675 |
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| [ ] BOTH sessions (all 4 weeks) $1145 |
|
| [ ] Add-on session (July 28-Aug. 1) $350 alone (or
JUST 250 if you are
signing up for one or both sessions) |
+ |
| Early drop-off (either babysitting or Yoga) $50/week |
|
| Deduct $25 for a second camper (sibling) |
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| Total due |
$ |
| Total enclosed. For
a payment plan, email roberta@pranacenter.com |
$ |
Refund policy: Your tuition is nonrefundable UNLESS we are able to
fill your child's spot, in which case we will refund your tuition less a
$25 handling fee.
Please read and sign the following.
Your signature indicates you have read, understand and agree to comply
with the statements listed here: I release the Prana
Center and
staff from all liability in connection to any personal injury and/or
damage to or loss of personal property while engaged in program activity. 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.
I give Prana Center permission to use pictures of my child in publicity and/or on their
website, facebook pages, or other electronic media.
Date ___________ Signature of
Parent or Guardian _______________
Please make checks
payable to Prana Center. Mail to
Prana Center, 21F Charles St., Holliston, MA 01746. Questions?
roberta@pranacenter.com |