Clone of Mind and Motion Registration Form

Mind and Motion Registration Form

Led Kaylea Philobos, Certified Health and Wellness Coach and Former Division I Softball Player, Mind & Motion gives young women a space to slow down, recharge, and strengthen both their mind and body. Through movement, mindfulness, and connection-building, girls learn tools to manage stress, build confidence, and navigate school and life with greater balance and self-belief.
March Workshop Details:

Join us on March 25th, designed for girls ages 13–16. This month's event will include guided journaling, gentle movement, breathing exercises, and practical strategies to help girls stay present, calm, and focused in the middle of busy school, sports, and everyday life. The workshop runs from 10:00 AM to 12:30 PM at The HUB, 128 S Southwinds Rd, Suite #11, Farmington, AR.
I confirm that my child is available to attend this workshop at the scheduled time and that transportation to and from the event is arranged.

Confirmed
Participant Information
Child's Full Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Parent/Guardian Information

A parent or guardian must complete this section.
Parent/Guardian Full Name*

First NameLast Name
Relationship to Participant*
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Waiver and Liability Release

This form is required for participation in Mind and Motion workshops facilitated by Kaylea Philobos of KP Performance & Wellness Coaching. Please complete the below waiver prior to participation This waiver remains valid for all future participation unless revoked in writing by the parent or legal guardian.
Mind and Motion Workshop Consent and Liability Waiver

1. Acknowledgment of Risk
I, {q8_fullname6}, the undersigned parent/guardian, acknowledge that {q3_fullname1} participation's in the Mind & Motion workshop, facilitated by Kaylea Philobos and KP Performance and Wellness Coaching at the facility, involves physical activity, movement exercises, mindfulness activities, and group interactions. I understand that while reasonable precautions will be taken, injury, illness, or harm may occur, including minor bumps, strains, or other unforeseen incidents.

2. Waiver and Release of Liability
In consideration for allowing my child to participate in the Mind & Motion workshop, I hereby release, waive, and discharge Kaylea Philobos, KP Performance and Wellness Coaching, their owners, instructors, employees, volunteers, agents, and the facility/venue where the workshop is held from any and all liability, claims, demands, or causes of action of any kind, including negligence, arising out of or in connection with my child’s participation.

I understand and agree that I am assuming all risks associated with participation and will not hold Kaylea Philobos, KP Performance and Wellness Coaching, or the facility/venue responsible for any injury, accident, or other loss, whether foreseen or unforeseen.

3. Medical Treatment Consent
I authorize emergency medical treatment for my child if necessary and acknowledge that I am responsible for any associated costs.

4. Photography/Video Release
I consent to the use of photographs or videos taken during the workshop for promotional or educational purposes by Kaylea Philobos and KP Performance and Wellness Coaching.

5. Compliance and Conduct
I understand that my child is expected to follow all workshop rules and instructions. I acknowledge that failure to follow guidelines may result in removal from the workshop without refund.

6. Cancellation Policy
I understand that cancellations must be made at least 24 hours prior to the workshop in order to avoid being charged the full workshop fee. Cancellations made less than 24 hours before the workshop will incur the full charge.
By signing below, I acknowledge that I have read and agree to the terms of the workshop waiver and release of liability. I understand the risks involved and consent to my child’s participation.*

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Mind and Motion Workshop Registration

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Mind and Motion Registration Form

March Workshop Details:

Participant Information

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Waiver and Liability Release

Mind and Motion Workshop Consent and Liability Waiver