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Let’s Move Together

This will take 2–3 minutes and helps us support you better. To be completed with a parent/guardian.

First name*

Last name*

Preferred contact method

Email

Text

Email*

Phone

Parent/ Guardian's Full Name *

Parent/ Guardian's Email*

Parent/ Guardian's Phone Number

Health conditions*

Allergies ( food, medication, environment)

Heart Condition

Back, joint or muscle injury

Surgery or hospitalization in the past year

Neurological condition ( seizures, etc.)

Other

Has the teen participated in yoga before?

No

Yes

What does your teen hope to get from yoga?*

Improve flexibility

Reduce stress

Build strength

Enhance focus

Help with sports performance

Have fun/ try something new

Other

How did you hear about our teens yoga program?

Friend/ Family

School

Website

Flyer/ Poster

Other

On a scale of 1-5, how comfortable is the teen trying new physical activities?

1- Not comfortable at all

5- Very comfortable

Anything else you'd like me to know before we connect?

Move . Meditate. Let go . Lighten up .

Move . Meditate. Let go . Lighten up .

Move . Meditate. Let go . Lighten up .

Move . Meditate. Let go . Lighten up .

Motion to Meditation

Where motion and stillness meet; a holistic practice for teens and adults in Austin, TX

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