Register

Registration Form

To enroll your child, please follow these steps:

Fill out the form below.
Read the waiver, release, assumption of risk, and authorization to publicize below the form.
Click the “register” button to send us your info and accept the waiver.
Make payment via Venmo, Check or Cash.

Please fill out the registration form and sign the waiver.
Child's Full Name*
First Last
Age*
Parent/Guardian Name*
First Last
Email*
Phone*
Select school or program*
Health Concerns/Allergies
Comments/Questions
Payment Method
- Venmo
- Cash
- Check
Venmo @Laura-Rubino *Checks can made out to Laura Rubino
Before submitting this form, please read the below medical release waiver. But submitting this enrollment form, you're "signing" the waiver and agreeing to it. Signing it also gives Higher Minds permission to use photos of your child we take during class on our social media channels.

A child's spot in the class is confirmed when the registration form and waiver are completed and payment is made.

Policy: there will be no make up classes if your child misses a class.

Waiver, Release and Assumption of Risk;
Authorization to Publicize

This Waiver, Release and Assumption of Risk; Authorization to Publicize (the “Waiver, Release and Authorization”) is made by the undersigned parent or guardian (the “Guardian”), on behalf of the minor child listed on the registration form (my “Child”), which Child intends to participate in the HIGHER MINDS yoga and mindfulness classes (the “Program”) provided by Higher Minds, LLC (the “Company”). For good and valuable consideration and intending to be legally bound, I do hereby agree to the terms and conditions set forth in this Waiver, Release and Authorization.

I AM AWARE AND UNDERSTAND THAT MY CHILD’S PARTICIPATION IN THE PROGRAM MAY INVOLVE THE RISK OF BODILY OR PERSONAL INJURY AND/OR DEATH AND/OR ILLNESS AND/OR IMPAIRMENT AND/OR PROPERTY DAMAGE. I ACKNOWLEDGE THAT MY CHILD IS VOLUNTARILY PARTICIPATING IN THE PROGRAM WITH KNOWLEDGE OF THE DANGERS INVOLVED AND I HEREBY AGREE TO ACCEPT AND ASSUME, ON BEHALF OF MYSELF AND MY CHILD, ANY AND ALL RISKS OF INJURY, DEATH, ILLNESS, IMPAIRMENT OR PROPERTY DAMAGE, WHETHER CAUSED BY THE NEGLIGENCE OF THE COMPANY OR ANY OTHER RELEASEE (AS DEFINED BELOW) OR OTHERWISE.

I recognize that my Child must adhere to the safety rules governing the Program, including the rules of the facility where the Program is provided (the “Facility”). Further, I understand and acknowledge that the Program includes inherent risks that cannot be completely eliminated regardless of the care taken by the Company. If an emergency arises, I hereby authorize the Company to request and/or administer medical treatment to my Child as necessary.

I hereby expressly waive and release, on behalf of myself and my Child, any and all claims, known or unknown, foreseen or unforeseen, against the Company, the Facility and their respective officers, managers, employees, instructors, agents, representatives, affiliates, owners, successors and assigns (collectively, “Releasees”) for bodily or personal injury, death, illness, impairment or property damage arising out of or attributable to my Child’s participation in the Program, whether caused by the negligence of the Company or any other Releasee or otherwise. On behalf of myself and my Child, I covenant not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims.

I shall defend, indemnify and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs or expenses of whatever kind, including reasonable attorney fees, the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, arising out of or resulting from any claim related to my Child’s participation in the Program.

I understand that in consideration for my Child’s participation in the Program, the Company may use and publicize the name, image, likeness, and other personal characteristics of my Child in photographic or video form for any legal use, including but not limited to publicity, marketing, advertisements, and web or social media content. As the Guardian of my Child, I hereby irrevocably grant, permit, authorize and license Company and its affiliates, successors, and assigns, and their respective licensees, publishers, and fulfillment agencies, and their respective employees, officers, directors, managers, representatives and agents (“Authorized Persons”), to display, publicly perform, exhibit, transmit, reproduce, digitize, modify, alter, edit, adapt, create derivative works and otherwise use and publicize, and permit other Authorized Persons to use and publicize, my Child’s name, image, likeness and other personal characteristics, and all materials created by or on behalf of the Company that incorporate any of the foregoing on a perpetual basis throughout the world, without further consent from or royalty, payment or other compensation.

I hereby certify that I am of legal age and mental competence to knowingly give this Waiver, Release and Authorization, which Waiver, Release and Authorization shall legally bind me and my Child, spouse, personal representatives, executors and heirs. If any term or provision of this Waiver, Release and Authorization is invalid, illegal or unenforceable in any jurisdiction, such invalidity, illegality or unenforceability shall not affect any other term or provision of this Waiver, Release and Authorization or invalidate or render unenforceable such term or provision in any other jurisdiction. This Waiver, Release and Authorization shall inure to the benefit of the Company and its successors and assigns. All disputes arising out of or relating to this Waiver, Release and Authorization shall be governed by and construed in accordance with the laws of the State of New Jersey, notwithstanding the choice of law rules of such jurisdiction or any other jurisdiction.

BY SIGNING, I ACKNOWLEDGE AND AGREE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS WAIVER, RELEASE AND AUTHORIZATION AND THAT (i) I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY, AND (ii) I AM PERMITTING THE COMPANY TO USE AND PUBLICIZE MY CHILD’S NAME, IMAGE, LIKENESS, AND OTHER PERSONAL CHARACTERISTICS AS SET OUT ABOVE.