Core Confidence Registration

Full Name*

First NameLast Name

Phone Number*

E-mail*

example@example.com

Would you like to be added to my newsletter?*

YesNo

I will be participating:*

In person (SOLD OUT)Via zoom

How did you hear about this series?

Release and Waiver of Liability

I understand and agree to the following:

Any type of yoga and exercise requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

It is my responsibility to consult with a physician prior to and regarding my participation in any yoga/exercise class. I represent and warrant that I am physically fit and have no psychological, medical or emotional condition that would prevent me from safe participation in any yoga/exercise class.

Alison Tjong may provide physical adjustments during class to correct alignment and/or focus my concentration on a particular muscle area to be targeted. It is my responsibility to inform Alison at the beginning of class if I do not want such physical adjustments.

It is also my responsibility to inform Alison when an adjustment has gone as far as I desire at the time.

Yoga/exercise is not a substitute for medical attention, examination, diagnosis or treatment.

Yoga/exercise is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga/exercise.

I release and discharge Alison Tjong from any and all liability, claim, demand or action that I may have resulting from injury, death or damages arising from my participation in the class/workshop/private session or at the studio premises, including loss that may be caused by the negligence of the released party. This includes classes/workshops held away from Alison Tjong’s premises.

I give Alison Tjong the express permission to take and use photos and videos of my likeness and I will provide written approval for her to use these pictures/videos for promotional purposes.

All purchased classes are non-refundable.

I understand that Alison Tjong operates on a scheduled appointment basis for all personal sessions and thus, requires that I provide 24 hours notice when canceling an appointment. No charge will be levied should I cancel with MORE than 24 hours notice given.

I recognize that this agreement of release and waiver of liability is a legal contract and that, by reading it carefully, I have complete knowledge of its contents.

I accept and agree to the outlined terms and conditions of this agreement, and sign it of my own free will and I am over the age of 18.

Please provide 24 hours notice if you need to cancel or reschedule your appointment.

Signature*

Date:*

Please mark yes or no to the following:

	YES	NO
Has your doctor ever said you have a heart condition and only recommended medically supervised physical activity?
Do you frequently have pains in your chest when you perform an activity?
Have you had chest pain when not doing physical activity?
Do you lose your balance due to dizziness or do you ever lose consciousness?
Do you have a bone, joint, or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anemia, epilepsy, respiratory ailments, back problems, etc.)?
Are you pregnant now or have you given birth in the last 6 months?
Have you had a recent surgery?

Please include information on ANY surgeries (cosmetic, outpatient, injury repair,reconstructive, laparoscopic, etc.), injuries, pregnancies, deliveries, cesareans, etc.

Please use this section to describe why you've decided to join the program. Include any relevant history or pain, discomfort, surgery and injury. Please also mention any stresses in your life which are above your usual. Please also include any emotional difficulties or anything in your whole body – physical, emotional, social that are of significance.

Payment is $197 and can be made by e-transfer to info@alisontjong.com or by credit card using the form below. Please note, payment must be received to secure your spot. Once payment is received, you will receive a confirmation email within 24 hours.*

I am sending an e-transfer to info@alisontjong.comI am paying with credit card (Be sure to click the box for the appropriate series below before entering credit card information)

My Products

Core Confidence

$197.00CAD Quantity

Postpartum Return to Exercise

$98.00CAD Quantity

Strength & Sculpt

$67.00CAD Quantity

Total

$0.00CAD

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