Registration and waiver Form For Yoga

Doris Puehringer RYT-500 – Yoga Therapist

Registration and Release Form

Name*

First NameLast Name

Phone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Occupation

Birthdate

Date

How did you hear about me

Yoga Background

Injuries / Medical History

(please be specific!)

Emergency Contact

Phone Number

DISCLAIMER/RELEASE FORM

Please read carefully!!

I am aware that Doris Puehringer is here to serve me by sharing her knowledge of yoga therapy and health awareness. By my participation in classes or activities with Doris Puehringer, I agree to take full responsibility for not exceeding my limits in the practice of yoga, and for any injury I might suffer in the practice of yoga. It is my responsibility to ascertain that there is no medical reason to prevent my participation. In consideration for Doris Puehringer yoga operations,

I waive any claim that I might have at any time for injury of any sort against Doris Puehringer and any person or entity involved therewith. This release waives the provisions of the California Civil Code, Section 1542, which provides: “A general release does not extend to claims which the creditor does not know to exist in his favor at the time of executing the release, which if known to him must have materially affected his settlement with the debtor.” I do hereby waive and relinquish all rights and benefits I have, or may have, under Section 1542 of the Civil Code of the State of California to the full extent that I may lawfully waive all rights and benefits pertaining to the subject matter of this Agreement for which a release has been given. I have carefully read this release, fully understand it, and agree to the above.

Cancellation procedures: I must be notified by e-mail, 24 hours prior to the appointment that had been scheduled, of any cancellation. If this is not complied with, you will be charged the full amount of the session that was to have taken place.

Date Signed*

Date

Signature of Participant*