registration form

Name:

____________________________________________________________

Address:

____________________________________________________________

____________________________________________________________

Phone: Email:

_________________________ ______________________________

Class

____________________________________________________________

Date:

_________________________

Amount enclosed

_________________________

I understand that Evolving Therapies Studio is not responsible for lost or stolen property. By signing this form, I acknowledge that Rebecca Lawson or Evolving Therapies Studio is not responsible for injury to my person or property. I am participating in the class or workshop willingly and with personal responsibility.

Signed:

___________________________________ Date:________________________________________