Name *

First Name

Last Name

Phone *

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date of birth *

(###)

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I have made my payment to confirm my place (please speak to Rosie if you need financial support) *

Please make a direct deposit to Rosie Santos Venmo @thegoodspace Zelle: 8053305705

$200 deposit

$750 early bird pay in full

$550 second deposit

$880 after early bird

Other

Liabilty Waiver

I understand that Zenthai Level 1 involves physical and interactive practices, and in choosing to attend this class, I have assessed I am of a reasonable level of physical and mental health to be able to safely participate. If I am unsure, I will check with my health professional and Rosie or Brad before joining the class. I take full responsibility for any injuries that I may incur. I understand that the instructions are to be followed to minimize risk of injury.

I understand nd acknowledge self responsibility for my health.

My full name (Signature)

First Name

Last Name