Integrity of Self MovementArts

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 prevent their physical participation in the Sessions.

Check to Confirm *

Integrity of Self MovementArts reserves the right to use images and videos taken in classes and programs for promotional purposes. Photographs and videos taken during class, educational conferences, or workshops may be used by Integrity of Self MovementArts for publicity purposes.

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."

How did you hear about ISMA classes?

If Gift Certificate Recipient, Name Presenter

Select the Class(es) of Interest.