Yoga Student Waiver

Name:*

First NameMiddle NameLast Name

Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail Address:*

Phone Number:*

Area CodePhone Number

Would you like to be included in Peace of Her Mind's monthly email newsletter?

Yes please
No thank you

Would you like to be included in Peace of Her Mind's weekly text Remind for weekly class offerings?
Yes please
No thank you

Do you have any yoga experience? This is not a requirement for class. :)*

Answer here

Do you have any medical restrictions or conditions I should be aware of?*

Answer here

What would you like to gain from your yoga practice?*

Answer here

Workout Disclaimer: I hereby consent I am voluntarily participating in yoga practice in-person and/or virtual yoga class (live or recorded) and I agree to assume all risks involved. I release Peace of Her Mind Yoga LLC, Tanya Coggin and/or YogaFaith from any injury, accident, or hazard related to yoga practice. I cannot hold Peace of Her Mind Yoga LLC, Tanya Coggin, and/or YogaFaith responsible for any liability. I recognize that any form of physical activity that I voluntarily participate in could be a potential risk, including risk of possible injury or even death. I hereby affirm that I am voluntarily participating in these activities whether in-person and/or virtual yoga classes with the knowledge of the risk involved. I agree to expressly assume and accept any and all risk of injury and/or death. I hereby affirm myself to be physically sound and suffering from no condition, ailment, impairment, disease, or other illness that would prevent my participation in in-person and/or virtual yoga classes. I've disclosed any medical issues related to participation. I affirm that I'm in physical condition to participate in class with Peace of Her Mind Yoga LLC, Tanya Coggin, and/or YogaFaith.**

Type your name as digital signature

I agree to workout disclaimer.