Online Pop Up Class with Helen

Preferred Method of Payment: (Zoom link will be e-mailed upon receipt of payment) *

eTransfer to namaste@helenfongyoga.com Credit Card (invoice me) PayPay via website By Donation Other

Class Style *

Drop-in Date

Date

Preferred Option: *

Drop-in $10 CAD Yoga Pass Other

Your Full Name *

First Name Last Name

Email Address: *

example@example.com

Phone Number *

Please enter a valid phone number.

Emergency Contact Name: *

First Name Last Name

Emergency Contact Phone: *

Please enter a valid phone number.

Do you have any conditions or injuries that could affect your Yoga practice? *

Yes No

If Yes, please inform us of any details, below.

Would you like to stay in touch with Helen?* *

Yes, I consent to receive Helen's weekly newsletter Yes, I consent to receive occasional yoga promotions and event news only No, I do not consent to be added to any mailing lists

*Privacy Statement. Your e-mail will only be used for the above stated purpose.

Waiver of Liability

I am aware that the classes may place a degree of stress to my muscular systems and or cardiovascular systems. I understand that I am cautioned not to overwork my body and to do only the movements or positions I am physically capable of executing. I understand that Helen Fong is a Certified Yoga Teacher who can only provide guidance under the Scope of Ability in this specialization. I understand that before participation in the yoga classes I should receive medical clearance from my physician. I understand that I am solely responsible for supervising and guarding the health and safety of myself. I hereby release and waive for myself, my heirs, any and all rights to claims for damages arising from any illness, injury occurence or aggravation to myself as a result of participation.

Printed Name *

Signature *

Clear

Today's Date *

Date