New Customer Registration Form

New Yoga Registration

One form per student
Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City/ Suburb	State
Post Code	Country

Phone Number
E-mail *
Emergency Contact Name

First Name Last Name
Emergency Contact Phone Number
How did you hear about us? *
Other
Are there any injuries/illness, or operations that could possibly impact physical capability? Are you pregnant? *
If none apply, please enter 'N/A'

Are there any two people whom you feel would appreciate hearing from me?:

Full Name

Contact Number

Email Address

1

2

For the purpose of my own health and wellbeing, and the dedication of my yoga instructor to provide a professional service, I agree to the following:
- I am Participating in Yoga classes which I will receive information and instruction about yoga and health.
- I am aware that yoga requires physical exertion, and may be strenuous, and I am aware of the risks and hazards involved.
- I am aware that it is my responsibility to consult with a physician, prior to and regarding the yoga classes.
- I represent and warrant that I am physically fit and have no medical condition that would prevent my full participation in yoga classes.
- I will faithfully follow the instructions for all the yoga poses given by my yoga teachers, as to where, when and how to perform them during yoga classes. It will be understood that any deviation by me from the given instructions will be at my own risk. I will not hold your instructors legally or financially responsible for any injuries suffered by me, caused in whole or in part by my failure to faithfully follow the instructions by your instructors, or any physical impairment of mine, not fully disclosing to you in writing.
- I understand that the tuition paid here-with are non-refundable and non-transferrable. Any refunds, if any, will be made entirely in the discretion of New Day Yoga.
Signature: *

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