Schedule Appointment with The Center for Feldenkrais and Movement Arts

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Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
E. Single Class/Drop-in		$17.00
Total: $17.00	Coupon:

My participation in this activity is voluntary.

I hereby assume full responsibility for all risk of injury or loss which may result from my participation in this activity and hereby release Fritha Pengelly from any and all liability arising out of or related to her classes.

I declare that I fully understand the nature of the activity in which I am participating, and any questions that I have had, have been answered to my satisfaction.

I also certify that I am 18 years of age or older.