Online Pop Up Class with Helen

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

eTransfer to namaste@helenfongyoga.comCredit Card (invoice me)PayPay via websiteOther

Class Style*

Preferred Option:*

Drop-in $15 CADYoga Pass$75 for 6 class (Yoga Nidra Special)Other

Start Date or Drop-in Date

Date

Your Full Name*

First NameLast Name

Email Address:*

example@example.com

Phone Number*

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Emergency Contact Name:*

First NameLast Name

Emergency Contact Phone:*

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

YesNo

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 newsletterYes, I consent to receive occasional yoga promotions and event news onlyNo, 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*

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Today's Date*

Date