Zen Kids Workshop Form

Parent Name *

First Name

Last Name

Phone *

You will not receive promotional text messages or alerts. In the event of an emergency during the program, we will contact you directly. You may also be contacted to follow up regarding your child’s program registration, if needed.

Country

(###)

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Child's Name *

Ages 7+

First Name

Last Name

Child's Name

Ages 7+

First Name

Last Name

Child's Name

Ages 7+

First Name

Last Name

Emergency Contact (Other Than Attendee) *

Please provide contact info in case of emergency.

First Name

Last Name

Emergency Contact (Other Than Attendee) *

Please provide contact info in case of emergency.

Country

(###)

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Love & Kindness Series - Tuesday August 19th, 2025 *

Day One (Please choose 1 time slot only.)

6:00PM - 7:00PM

7:30PM - 8:30PM

Love & Kindness Series - Friday August 22nd, 2025 *

Day Two (Please choose 1 time slot only.)

6:00PM - 7:00PM

7:30PM - 8:30PM

Scent Allergies. *

In the event, we use a diffuser with scent or some natural aromas during the session.

Yes, my child is allergic or sensitive to scents.

No, my child does not have any allergies or sensitivities to scents (e.g. essential oils, incense, or other natural aromas used during sound bowl or Reiki components.