Client Intake Form

Blooming Tree Yoga LLC

YOGA CLIENT INTAKE FORM-CONFIDENTIAL INFORMATION

WELCOME! We would like to make your yoga experience at Blooming Tree Yoga as effective and enjoyable as possible. If at any time you have any questions regarding your session, please let us know.

Name

Date of birth

Date

Address*

City, State, Zip*

Referred by (Name, Flyer, Ad website, ect)*

Yes(Date of last class/practice*

Date

Emergency Contact (Name & Phone Number*

Have you ever practiced Yoga Before?

NoYes

How do you rate your current level of activity? (pick one)

Is there any previous injuries, disorders, surgeries, or health conditions that we need to be made aware of?

Are you currently taking any medications?

PLEASE READ THE FOLLOWING INFORMATION AND SIGN BELOW:

I am delighted to have you as a client at Blooming Tree Yoga LLC. The following information will help you get the most out of your experience and clarify our instructor/student relationship.

I believe that Yoga is more than physical exercise. It is a transformative practice that integrates body, mind and emotional tensions to arrive at deeper levels of relaxation and awareness. All exercise programs involve a risk of injury. By choosing to participate in todays, and future classes, you voluntarily assume a certain risk of injury.

Awareness is fundamental to the practice of Yoga. By attending classes, I affirm that I am solely responsible for my health and well-being, as well as my decision to practice yoga, a program of physical exercise. I agree to inform my yoga instructor of any activities or movements, which I feel could cause injury to myself. I understand that yoga is not recommended and is not safe under certain medical conditions. I do not have any physical conditions or disability that would limit my participation or preclude an exercise program. Blossoming Tree Yoga and the owner of the facilities shall not be held liable for any injury, loss or damage to property and/or persons sustained during or as a result of participation in this class. I agree to listen to my body and monitor myself during every class session. I also understand that photos, and/or videos may be taken during class and posted on social media or the company website for promotional reasons.

Signature

Date

Signature of Parent/guardian: (If person is under the age of 18)

Signature of Parent/guardian

Date