Your Name
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First Name
Last Name
Provide full address.
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
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Month
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Day
Year
Date
Experience
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None
Comfortable with Alignment Principals
Fluent in Pranayama
Knowledge fo Bandhas and their use
Main Reason for Taking Class
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Inner Peace
Gain Flexibility
Stress/Anxiety
Just curious
Healthier Habits
What is the date of event/class? (it this is an ongoing event - just write in the first date of series)
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Concerns? (Example: Pregnant, Can't be on knees, Spinal Stenosis, Herniated Disc, etc - anything here you list helps a Yoga teacher design their class. Please be as specific as possible.
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(Please write NONE if that applies)
If you would like a coupon for our studio: 4 Classes for $25 - please share your email!
example@example.com
COVID-19 or ANY Contagious illness
By submitting this form, I agree to not attend the Yoga Session if I have been in contact within 14 days of someone with COVID-19, as well as I do not show ANY symptoms of COVID-19 or any other contagious illness. We will do the same. During the pandemic, we secure a back up just in case!
Signature (agreement to intake form/terms & conditions
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