YFL Summer Program Registration

YFL Summer Program Registration Form

Please fill out the registration form below. Contact info@yogaforlifelv.com with any questions.
Participant Name*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Grade Level
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian*
NAME and PHONE of contact
E-mail*
example@example.com
Guardian Mobile Number*
Additional Parent/Guardian contact information *Important if anyone else is to pick up the child*
Anything specific you would like the yoga teacher to know about your child?
Would you like to be added to the YFL Newsletter mailing list and receive occasional emails about trainings, exclusive discounts, program updates, and community events? Your email is never shared, and we promise not to fill up your inbox. We generally share 1 per quarter.*

Yes! I want the awesome YFL newsletter!I already receive your inspiring newsletters!No thanks, I'll pass for now...
Cancellation Policy: all sales final. You must contact Jacky directly via email with any specific cancellation requests or questions. Exceptions may be made on a case by case basis. Jacky Pagone: info@yogaforlifelv.org*

Yes, I understand and agree with the cancellation policy.
Please verify that you are human*

Participant Agreement

Movement and Mindfulness Agreement

I understand that yoga and pilates includes physical movements as well as an opportunity for relaxation, healthy stress management and relief of muscular tension. Participation in yoga class includes, but is not limited to participation in meditation techniques, yogic breathing techniques, and performing various yoga postures. Yoga postures, or asanas, are designed to exercise every part of the body―stretching and toning the muscles and joints, the spine and the entire skeletal system. They also work on the internal organs, glands and nerves. Yoga incorporates sustained stretching to strengthen muscles and increase flexibility. Yoga is an individual experience.

As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. My signature acknowledges I understand that in yoga class I will progress at my own pace. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher. I will continue to breathe smoothly. If at any point I feel overexertion or fatigue, I will respect my body’s limitations and I will rest before continuing yoga practice.

Yoga is not a substitute for medical attention, examination, diagnosis or treatment. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Yoga For Life Las Vegas, Monkey Mind Management LLC, owners, employees, volunteers, and Yoga teachers.

By signing my name below, I acknowledge that participation in yoga classes exposes me to a possible risk of personal injury. I am fully aware of this risk and hereby release Yoga For Life Las Vegas, Monkey Mind Management LLC, owners, employees, volunteers, and Yoga Teachers from any and all liability, negligence or other claims arising from or in any way connected with my participation in yoga class.

My signature further acknowledges that I shall not now or at any time in the future bring any legal action against Yoga For Life Las Vegas, Monkey Mind Management LLC, owners, employees, volunteers, and Yoga Teachers; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors and my assigns. My signature verifies that my child is physically fit to participate in yoga classes and a licensed medical doctor has verified my physical condition for participation in this type of class.

My signature is binding to this liability waiver from this day forth.
Please confirm you have read and understand the Movement and Mindfulness Agreement and agree to speak with your child about the content of this agreement*

Yes, I understand, agree and will speak with my child about this agreement
Photo and Video Agreement

On occaision photos and short videos are taken during yoga and mindfulness classes. All virtual classes are recorded. Recordings may be edited for further teaching use.

I herby grant Yoga for Life Las Vegas and Monkey Mind Management LLC the right and permission to use photographs and/or video recordings of me on YogaForLifeLV.org and other websites, publications, promotional flyers, educational materials, promotional videos, instructional videos, social media, or for any other similar purpose without compensation to me.

I understand and agree that such photographs and/or video recordings of me/my child may be placed on the Internet, and used in social media. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video and audio recordings, and any reproductions thereof, and all digital files are and shall remain the property of Monkey Mind Management LLC.

I hereby release, acquit and forever discharge the Yoga For Life Las Vegas, Monkey Mind Management LLC, its current owners, employees, volunteers, and yoga teachers of the above-named entities from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation.

If for any reason you do NOT want to be seen or heard occaisionally in our social media feed, Youtube channel or website, no stress. We respect your privacy!
Please confirm you have read the Photo and Video Agreement.*

Yes, I have read and understand the Virtual Class Agreement.* only check this box if you do NOT want your image or voice used in any way. We absolutely respect your privacy!

Coronavirus/COVID-19 WAIVER

The coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. Monkey Mind Management LLC (MMM), Yoga For Life Las Vegas (YFL), has put in place preventive measures to reduce the spread of COVID-19. MMM YFL follows current CDC guidelines. MMM YFL cannot guarantee that you will not become infected with COVID-19.

ASSUMPTION OF RISK: By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury, illness, damage, loss, claim, liability, or expense, of any kind, that I may incur.

WAIVER OF LIABILITY: I hereby release, covenant not to sue, discharge, and hold harmless MMM YFL, its owners, employees, teachers, and volunteers, from all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating to COVID-19.

Please read carefully; I hereby agree to the following: I agree and acknowledge that I am fully aware that participation in this activity may involve risks and I accept all the risks of participating. I will progress at my own pace and I understand my physical limitations so I am sufficiently self-aware to stop physical activity before I become ill or injured. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the yoga classes. In consideration of being permitted to participate in the yoga classes, I knowingly, voluntarily, and expressly waive any claim I may have against MMM YFL for injuries or damages that I may sustain as a result in participating in the yoga classes. My signature acknowledges that I shall not now, or at any time in the future, bring any legal action against MMM YFL, and/or any owners, teachers, employees, or volunteers with MMM YFL; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors, and my assigns.

I agree to stay home if I have had any recent exposure to someone with COVID-19 or I am exhibiting any fever, cough or other symptoms. If you are under 18, you must have a parent’s signature. My signature is binding to this liability waiver from this day forth.
Please confirm you have read and agree to Coronavirus/COVID-19 Waiver*

Yes, I have read and understand, and will speak with my child about health and safety precautions regarding Coronavirus/COVID-19.
I have read this form in its entirety. Signature of responsible party.

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My Products

Summer SessionSummer Session includes 6 mindful movement classes from June 7th - June 14.

$70.00

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YFL Summer Program Registration Form

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