Registered For Children ISMA Classes

Student's Name *

Student's Birthday *

Parent or Guardian's Name (if under 18 years) *

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Phone Number

Email Address *

Emergency Contact Full Name *

Emergency Contact Phone Number *

Check to Confirm *

I hereby agree to and/or grant permission for my son/daughter to participate in Integrity of Self MovementArts Sessions. In consideration of the benefits in participating in the Sessions, I release and hold harmless Integrity of Self MovementArts and those acting on its behalf from any lawsuits, claims, and actions, arising from or connected with participation in these Sessions. I claim to the best of my knowledge, that my son/daughter do not have any medical/physical disability that would preclude their physical participation in the Sessions.

YES, I understand *

Please be aware that we deliver class information and approved flyers almost exclusively via email. We ask that you confirm your email directly after registering. To ensure a smooth delivery of our communication, we suggest you add "integrityofself@gmail.com" to your email contacts. When you receive your first eflyer, be sure to click "always display images."

YES, I understand *

I am signing up for weekly classes and after the first class, I understand that I will need to provide 30-day notice to withdraw from the program.

How did you hear about ISMA classes?

Photo Release, Kindly Check One

Yes, I give permission to be photographed and/or have my child photographed or videotaped in Integrity of Self MovementArts class for promotional use in publications, website, educational conferences or displays; or on television.No, I do not give permission to be photographed and/or to have my child photographed or videotaped in Integrity of Self MovementArts class for promotional use in publications, website, educational conferences or displays; or on television.

If Gift Certificate Recipient, Name Presenter

Select the Class(es) of Interest.

Toddlers: 10:30 - 11:15 AM on Wednesdays
Toddlers: 10:30 - 11:15 AM on Saturdays
Kids: 5:00 - 6:00 PM on Tuesdays
Kids: 11:30 AM - 12:30 PM on Saturdays
Juniors: 5:00 - 6:00 PM Wednesdays
Juniors: 2:00 - 3:00 PM Saturdays
Adults: 6:30 – 7:30 PM Wednesdays
Adults: 5:30 – 6:30 PM Thursdays
Private Classes: scheduled 55 min one-on-one class